December 2021 policy and protocol updates overview

Your notice of protocol and policy changes from UnitedHealthcare

Appendix Bulletins

Medical policy updates: December 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: December 2021
This month, you’ll find updates for Medicaid and commercial plans.

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

Prior Authorization

Radiology prior authorization update delay
Effective March 1, 2022, the updated procedure codes for the radiology prior authorization program for UnitedHealthcare commercial and Exchange plans will go into effect.

New prior authorization requirements for Individual Exchange plans
Starting March 1, 2022, the following clinical categories will require prior authorization for Individual Exchange plans.

Exchange plans: Prior authorization not required for outpatient therapy services
Starting Dec. 1, 2021, UnitedHealthcare Individual Exchange plans, also referred to as Individual and Family plans, will not require prior authorization for outpatient therapy services (physical, occupational and speech therapy), up to the member’s benefit limit.  

Massachusetts: Prior authorization and site of service update
Update Dec. 1, 2021: We previously announced a Jan. 1, 2022 implementation date for prior authorization and site of service reviews for certain surgical, screening colonoscopy, office and MR/CT imaging procedures for commercial plans in Massachusetts. 

Texas: Medicaid Prior Authorization changes for 2022
Effective Jan. 1, 2022, you’re required to submit a prior authorization when prescribing drugs prescribed for UnitedHealthcare Community Plan of Texas members with certain conditions.

Other policy and protocol updates

District of Columbia: Electronic payments required for UnitedHealthcare Community Plan 
Effective Jan. 1, 2022, UnitedHealthcare has made changes to its claim payment platform that will eliminate the use of paper checks for claim payments to Community Plan health care professionals in the District of Columbia.