September 2021 Network Bulletin overview

Your notice of protocol and policy changes from UnitedHealthcare

Appendix Bulletins
 

• Medical policy updates: September 2021
  This month, you’ll find updates for Medicaid, Medicare, Exchange and commercial plans.

• Pharmacy updates
  This pharmacy bulletin outlines new or revised clinical programs and implementation dates. It’s available online for UnitedHealthcare commercial and UnitedHealthcare Oxford commercial plans.
• Prior authorization and notification requirement updates
  We’re making changes to certain advance notification and prior authorization requirements that are available for you in the 2021 Summary of Changes.

• Reimbursement policy updates: September 2021
  This month, you’ll find updates for Medicaid and commercial plans.

• Specialty Medical Injectable Drug program updates: September 2021
  See the latest updates to requirements for Specialty Medical Injectable Drugs for UnitedHealthcare members.

Prior Authorization
 

• Radiology prior authorization updates
  Effective Dec. 1, 2021, procedure codes for the radiology notification and prior authorization programs for UnitedHealthcare Community Plan, Commercial and Exchange will be updated.

• Hysterectomy prior authorization criteria change
  NJ, PA
  Effective Nov. 1, 2021, UnitedHealthcare Community Plans (Medicaid, Long-Term Care) in New Jersey and Pennsylvania will have a criteria change to an existing hysterectomy prior authorization.

More state and regional policy and protocol updates
 

• Medical PRAs won’t be mailed after November
  AK, AL, FL, GA, IL, IN, IA, KS, KY, LA, MI, MN, MS, MO, NE, NC, ND, OH, OK, SC, SD, TN, WI
  Effective Dec. 10, 2021, for most* UnitedHealthcare plans in the region, we will no longer print and mail paper provider remittance advice (PRAs) for medical claims to network health care professionals and facilities (primary and ancillary).

• Medicare Advantage Service Area Reductions 2022
  Effective Jan. 1, 2022, some of your patients may be impacted by UnitedHealthcare Medicare Advantage plan service area reductions or plan terminations. Non-renewal notices dated Oct. 2, 2021, will be sent to impacted members.

• Mississippi: Electronic payments required for UnitedHealthcare Community Plan
  We will no longer send paper checks for claim payments to Community Plan health care professionals in Mississippi. This change is part of our efforts to speed up payments to your practice by moving to digital transactions.

• States Added to Medical Review for Self-administered Drugs
  CA, CO, CT, MS, NC, OK, RI, TX, VA
  Beginning Nov. 15, 2021, we are adding additional states for editing review based upon the UnitedHealthcare^® Commercial Medical Benefit Drug Policy – Self-Administered Medications.

• Texas: Maternal level-of-care reimbursement
  Effective Dec. 1, 2021, we will reimburse maternal services for Medicaid members receiving care in your facility that align with the assigned Texas Health and Human Services Commission (HHSC) level-of-care designations.

• Tufts Freedom Health Plan policy update
  MA, ME, NH, RI, VT
  Effective Nov. 1, 2021, UnitedHealthcare Policies and Protocols will apply to all Freedom Plan members.

CPT^® is a registered trademark of the American Medical Association. 

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