November 01, 2022

November monthly overview

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

Nov. 1 publication

Policy and protocol updates

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

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

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

State news

Chemotherapy prior authorization update
The UnitedHealthcare Community Plan of Hawaii will be added to the prior authorization requirement for chemotherapy drugs.

Schedule follow-up after ED visit for substance use
To improve care delivery for substance use patients, schedule a post-discharge appointment within 7 days of ED visit. 

STAR+PLUS billing unit change 
As of Sept. 1, 2022, you should bill Financial Management Services Agency (FMSA) units for STAR+PLUS as 1 unit per month.

Digital updates

Reconsiderations and appeals going digital
Starting in February 2023, reconsiderations and appeals for commercial and Medicare plans must be submitted electronically.

VCP statements going digital starting Feb. 3 
Starting Feb. 3, 2023, VCP statements won’t be mailed to commercial and Medicare advantage providers and facilities.

Training and resources

Complete Special Needs Plan MOC training
Our SNP MOC training is available as a self-paced course and takes about 10 minutes to complete.

Prescription formulary updates

Individual Exchange PDL update 
On Jan. 1, 2023, we’re making prescription drug list updates for UnitedHealthcare Individual Exchange plans.

Reimbursement and process changes

Rocky Mountain Health Plans claims updates
Participating health plans and UnitedHealthcare providers will receive information and training opportunities.

New medical necessity criteria for HBOT
We will only consider HBOT services for CPT codes 99183 or G0277 medically necessary for some diagnosis codes.

New home health prior authorization review process
Starting Feb. 1, 2023, you’ll need to request prior authorization for all visits after the Start of Care (SOC) visit.

Annual wellness visit reimbursement increase
UnitedHealthcare Community Plan wellness visit reimbursement increase through Dec. 31, 2022. 

Change in post-acute care management 
Effective Jan. 1, 2023, UnitedHealthcare will manage the Medicare component of some HIDE or FIDE-AIP plans.

Nov. 17 publication

Policy and protocol updates

Medicare: Part B step therapy prior authorization requirements
Effective for dates of service starting Jan. 1, 2023, we will require prior authorization for medications included in the UnitedHealthcare® Medicare Advantage Part B step therapy program.

Action required for Medicaid wage increase
The Agency for Health Care Administration requires Medicaid providers to sign a wage increase agreement by Oct. 1, 2022.

Medical necessity documentation requirements
Please include supporting clinical documentation for medical necessity when submitting prior authorization requests. 

New Jersey Medicaid enforcing national drug code
The national drug code requirement will be enforced for prescription Medicaid claim submissions.

Where to find documents as they go digital-only
Where to view digital-only documents (Document Library in the portal), why you might still get mail, tips and exceptions.

New hospital observation and inpatient policy
New observation and inpatient policy effective, Dec. 1, 2022, for several health plans.

Updated review process timing for sepsis-related treatment
As of July 1, 2022, Medicare Advantage and commercial claims for sepsis-related treatment may be reviewed on a pre-payment or post-payment basis.

New oral oncology prior authorization process
Effective Dec. 1, 2022, you can submit chemotherapeutic prior authorization requests using the Medical Benefit Management Now (MBMNow) tool for patients.

State news

Mississippi Medicaid: MESA system now live
DOM has developed a new Medicaid Management Information System to replace the aging Envision system.

Pharmacy and health plan updates

Support medication adherence with 90-day fills
You can help improve medication adherence by prescribing 90-day medication fills for your behavioral health patients.

All Savers health plans to get new ID numbers 
All Savers plans in AL, CT, DE, ND, NJ and SD will integrate into other UnitedHealthcare commercial plans on Dec. 1, 2022.

Rocky Mountain Health Plans transition 
Credentialing information for Colorado Rocky Mountain Health Plan Providers

2023 MAPD core and C-SNP formulary improvements
For 2023, there will be 26 down-tiered drugs and 4 formulary additions to the MAPD core formulary and C-SNP formulary.

Support your patients from A to Z
Screen patients for social determinants of health and use Z codes when submitting claims.

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