This pharmacy bulletin outlines new or revised clinical programs and implementation dates. It’s available online for UnitedHealthcare commercial and UnitedHealthcare Oxford commercial plans.
Specialty pharmacy drug list update – Nulibry ™
Effective for dates of service beginning on Dec. 1, 2021, we’re adding the following specialty medications to our specialty pharmacy requirements drug list for UnitedHealthcare commercial plans.
Medicare clinical submission requirement change
Effective Feb. 1, 2022, UnitedHealthcare will require you to obtain prior authorization for PT, OT and ST services delivered at multi-disciplinary offices and outpatient hospital settings. These prior authorization requirements apply to patients new to therapy and those who are currently receiving therapy.
Prior authorization changes for private duty nursing
Starting Feb. 1, 2022, we’ll require prior authorization for the complimentary benefit of private duty nursing (HCPCS code T1000) offered to designated Medicare Advantage® retiree plans through UnitedHealthcare Retiree Solutions.
Electrophysiology implant prior authorization update Starting Dec. 1, 2021, we’ll no longer require prior authorization and notification for electrophysiology implant procedures subject to the UnitedHealthcare outpatient cardiology notification/prior authorization protocol when performed and appropriately billed as an inpatient service for UnitedHealthcare Community Plan, Medicare Advantage®, commercial and Exchange plan members.
Northeast: Medical PRAs going paperless in February CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VA, VT, WV
Starting Feb. 4, 2022, 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).
New Medicare Advantage plans for 2022
Effective Jan. 1, 2022, more UnitedHealthcare® Medicare Advantage plans, including Dual Special Needs Plans (DSNP), will be available with options in new states and counties.
UnitedHealthcare — committed to price transparency and disclosure As part of our commitment to improving the health care system, all Participation Agreements between UnitedHealthcare and health care professionals, medical groups, facilities and ancillary providers will be interpreted consistently with government-mandated price transparency and disclosure.
CPT® is a registered trademark of the American Medical Association.