Medical policy updates: May 2022
This month, you’ll find updates to our commercial, commercial affiliate, Exchange Plans, Community Plan, and Medicare Advantage medical policies.
Reimbursement policy updates: May 2022
See the latest updates for reimbursement policies.
Specialty Medical Injectable Drug program updates: May 2022
See the latest updates to requirements for Specialty Medical Injectable Drugs for UnitedHealthcare members.
Colorado: More letters going paperless Aug. 5, 2020
We will no longer print and mail certain medical claim-related letters for most commercial and UnitedHealthcare® Medicare Advantage health plans to network health care professionals and facilities in Colorado.
Minnesota Medicaid: Prior authorization required for cognitive rehabilitation services as of June 1, 2022
Prior authorization will be required for cognitive rehabilitation services (procedure code H2012 HK) for UnitedHealthcare Community Plan members enrolled in Families & Children and MNCare plans.
Nebraska Medicaid: Temporary per diem rate increase for nursing and assisted living facilities
Nebraska Medicaid is increasing per diem rates by $20 per day for nursing and assisted living facilities for dates of service between Jan. 1, 2022, and June 30, 2022.
New Jersey Medicaid: Radiation therapy prior authorization updates effective July 1
Prior authorization will be required for certain outpatient radiation therapies for UnitedHealthcare New Jersey Community Plan Medicaid members.
New York: Billing for children and youth in foster care and other resources
Effective July 1, 2021, Voluntary Foster Care Agencies (VFCAs) would no longer be the payor for services of children or youth in foster care.
New York Medicaid: DMEPOS Limit Policy enforcement begins Aug. 1
UnitedHealthcare will start enforcing Durable Medical Equipment, Prosthetics, Orthotics, and Supplies policy as published by the New York State Department of Health.
New York Medicaid: APG guidelines enforcement begins Aug. 1
UnitedHealthcare Community Plan New York will start enforcing Ambulatory Patient Groups (APG’s) guidelines as published by the New York State Department of Health.
Medicaid: Outpatient prior authorization process updates for non-oncology drugs
Optum®, an affiliate of UnitedHealthcare, will manage prior authorization requests for non-oncology injectable medications that are covered on the medical benefit for UnitedHealthcare Community Plans.
Therapeutic Radiation Prior Authorization Training on May 18
Navigate the new notification/prior authorization request process for outpatient radiation oncology therapies.
Missouri: Health Homes training now available
This online training module for primary care and behavioral health homes outlines the basic functions and responsibilities of both the health home providers and UnitedHealthcare.
Texas Medicaid: National Provider Identifier required for certain claims submissions
The Texas Medicaid & Healthcare Partnership (TMHP) requires the service facility to include their National Provider Identifier (NPI) on these claim submissions forms or their electronic equivalents.
Medicare Advantage: Prior authorization and site of service expansion for surgical procedures
Starting May 1, 2022, for UnitedHealthcare Medicare Advantage plans, we’re expanding our prior authorization requirements and site of service medical necessity reviews for certain surgical procedures.
RADV audit program launching in June
We are required to provide supporting medical documentation to enable the audit of medical encounter(s) for UnitedHealthcare members.
Oxford Health Plans: Beginning in August 2022, medical PRAs will no longer be mailed
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),
Action needed – Your directory phone number may be incorrect
Please review your phone numbers at each place of service to ensure they are accurate. Out-of-service or otherwise incorrect phone numbers can make it difficult for members to set up appointments or follow up with you after an office visit.
See coverage changes for prenatal ultrasounds
Starting June 1, 2022, there’s a new obstetrical ultrasound medical policy for UnitedHealthcare Individual Exchange plan members.
Understanding Care Cash
Certain plan members in your area are eligible to receive Care Cash, a prepaid debit card that supports them with out-of-pocket expenses and guides them to care in our network.