December 01, 2022

December monthly overview

Network News is published twice a month. See updates below.

Dec. 1 publication

Policy and protocol updates

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

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

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

State news

Florida Medicaid: Increased OBRAF incentive
Earn an increased incentive for OBRAFs completed for UnitedHealthcare Community Plan members before Dec. 31. 

Illinois: Prior authorization and step therapy changes
Effective Jan. 1, 2023, Optum will manage prior authorization and step therapy requests for prescription medications. 

Maryland: Updated emergency room auto-pay list
UnitedHealthcare recently expanded our emergency room auto-pay list effective Dec. 1, 2022. 

Minnesota Medicaid: New programs launching Jan. 1, 2023
Learn about new Minnesota Senior Health Options and Minnesota Senior Care Plus and Special Needs BasicCare plans. 

New Jersey: Attending physician NPI requirement
Beginning Jan. 1, 2023, we will require that all facility claims include a valid attending physician NPI. 

New Ohio Community Plan pharmacy benefit manager
Gainwell now manages pharmacy benefits for UnitedHealthcare Community Plan members in Ohio. 

Texas: Coordination of benefits and prior authorization
Medicaid is the last payer on a claim for members who have other health insurance. 

Virginia: Enroll in the new PRSS
Medicaid managed care network providers must enroll through PRSS to comply with the 21st Century Cures Act.

Process updates

Prior authorization updates for echocardiography
Starting Nov. 1, 2022, we will not require prior authorization for specific CPT® codes for commercial and Oxford plans. 

UnitedHealthcare Credentialing Plan updates
Review the latest changes to the UnitedHealthcare Credentialing Plan for the 2023-2025 time period. 

Program updates

Refer patients to Oxford Preferred Lab Network 
On Jan. 1, 2023, refer your New Jersey and New York Oxford commercial patients to Oxford Preferred Lab Network.

PCOR is transitioning to Practice Assist
In the coming months, you will access your PCOR via Practice Assist using your One Healthcare ID.

Rocky Mountain Health Plans
See the latest updates on the Rocky Mountain Health Plans transition. 

Oxford Metro Network updates
The Oxford Metro Network may let you provide services to your out-of-area Oxford patients.

Part B Step Therapy: Changes for 2023
Effective Jan. 1, 2023, we are making changes to the VEGF Inhibitors class and adding new drugs to Part B Step Therapy.

Training and resources

Annual lab testing for BH disorders
Annual lab testing is recommended for patients prescribed antipsychotic medications.

Behavioral health continuing education credits 
We offer a 3-part online series covering behavioral health issues seen in primary care settings. 

Treating patients with substance use disorders
Primary care providers play an important role in identifying and treating patients with substance use disorder.

Dec. 15 publication

State news

Arizona appointment availability surveys
AHCCCS requires us to conduct regular surveys to ensure our providers comply with state appointment availability standards.

New preauthorization form for all health plans
Use our new standardized preauthorization form beginning Jan. 1, 2023, for all Hawaii health plans. See exceptions.

Gender-affirming care resources
In September 2021, MassHealth launched a webpage offering details about several important gender-affirming care topics.

Medicaid ID required on all claim submissions
Beginning Jan. 1, 2023, we will deny all claims that do not include the provider’s Medicaid ID.

New York Medicaid: HIV clinical guidelines
UnitedHealthcare Community Plan of New York participating providers can access resources and clinical guidelines for HIV.

North Carolina Medicaid: Get training on EVV
You’re required to use electronic visit verification for home health visits starting in April. Here’s how to get trained.

Texas Medicaid: Billing changes for STAR+PLUS and STAR Kids
Dec. 1, 2022, the Texas Health and Human Services Commission (HHSC) will update the long-term services and supports (LTSS).

Process updates

Medical drug frequency review update
Effective March 1, 2023, we will conduct post-service medical claims reviews of certain drugs.

Updates to Medicare estimation process in 2023
Starting Jan. 1, 2023, we’re updating the Medicare estimation methodology for small group and large group businesses.

Prior authorization updates for radiation therapies
Starting Feb. 1, 2023, we’ll require prior authorization for some outpatient radiation therapies in Minnesota and Virginia.

Plan and program updates

Cancer Support Program expansion
As of Dec. 1, 2022, we have extended the Cancer Support Program to UnitedHealthcare Community Plans in several states.

You may see more Individual Exchange members
You may see an increase in Individual Exchange plan members as 2 health insurers exit the ACA Marketplace on Dec. 31, 2022.

Continuous glucose monitor pharmacy availability
Effective Jan. 1, 2023, CGM supplies will be made available through the pharmacy at the point-of-sale.

Surest tasks moving to Provider Portal
On Jan. 1, 2023, administrative tasks for Surest plans will begin moving to the UnitedHealthcare Provider Portal.

Training and resources

Your 2023 administrative guide is ready
View the updated 2023 UnitedHealthcare Care Provider Administrative Guide for commercial and Medicare Advantage plans.

Influenza prevention and treatment resources
We’ve assembled a summary of current clinical guidelines for influenza prevention and treatment.

Advancing Health Equity Education web series
We are pleased to offer a free, 1 CME credit web series on Advancing Health Equity Education.

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