August 01, 2022

August 2022 policy and protocol updates overview

Your notice of protocol and policy changes from UnitedHealthcare

Appendix Bulletins

Medical policy updates: August 2022 
Medical policy updates for July 2022 for the following plans: Medicare, Medicaid, Exchanges and commercial.

Reimbursement policy updates: August 2022
See the latest updates for reimbursement policies. 

Specialty Medical Injectable Drug program updates: August 2022
See the latest updates to requirements for Specialty Medical Injectable Drugs for UnitedHealthcare members.


Policy and protocol updates

Arizona: Rehabilitative therapy services updates
Review the benefit limits and prior authorization requirements for rehabilitative therapy services for UnitedHealthcare Community Plan of Arizona members.

Arizona Medicaid: Maternity requirements for substance use screening
The Arizona Health Care Cost Containment System (AHCCCS) updated its Substance Use Disorder (SUD) screening requirements specific to Medicaid members who are pregnant.

Overpayment letters going paperless
On Nov. 4, overpayment letters for most UnitedHealthcare community plans to network health care professionals (primary and ancillary) and facilities in HI and WI are going paperless. 

Texas Medicaid: Prior authorization changes 
Effective Aug. 31, 2022, you’re required to submit a prior authorization when prescribing Rinvoq® and Cibinqo™.

Texas correction: Shoulder surgery prior authorization
Corrected list of shoulder surgery codes requiring prior authorization for UnitedHealthcare Community Plan of Texas.

Temporary changes coming for select existing commercial plan claims
On Sept. 1, 2022, fully insured Individual and Group Market health plans for customers in AL, CT, IL, MN, MT, ND, NJ, OK and SD will move to a new claims processing system. Expect temporary changes.

New 2022 codes for Pediatric Congenital Heart Disease
Beginning Jan. 1, 2022, there are new CPT® codes in place for Pediatric Congenital Heart Disease. 

New codes added to the prior authorization list for Commercial plans
Starting Oct. 1, 2022, we’re adding additional codes to the prior authorization list for UnitedHealthcare Commercial plans. 

New additions to Cancer Therapy Pathways Program
As of Aug. 1, 2022, Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL) will be added to our Cancer Therapy Pathways Program.

TN, VA and WI Medicaid: Appeal decision letters won’t be mailed starting Nov. 4
Beginning Nov. 4, appeal decision letters for most community plans to network health care professionals (primary and ancillary) and facilities in TN, VA and WI are going paperless. 

Oxford Health Plans: Two fax numbers can no longer be used
Beginning Nov. 1, 2022, 2 more fax numbers can no longer be used to submit prior authorization and admission notifications.


State news

Texas Medicaid: Clean claims and other claim reminders
UnitedHealthcare Community Plan abides by Texas Medicaid Healthcare Partnership’s claims adjudication requirements for clean claims.

Texas Medicaid: Measures that make a difference in patient care
We’ve created a summary of key quality measures to give you a quick resource for providing optimum care for your patients.

Rhode Island: Important changes for providers serving Medicaid members
Beginning Sept. 1, 2022, you’ll see changes to our claims processing platform, the provider Call Center phone number and Member ID numbers.

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