October 01, 2022

October monthly overview

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

Oct. 1 publication

Policy and protocol updates

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

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

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

New Jersey: Prior authorization and site of service expansion
As of Nov. 1, 2022, we’re expanding prior authorization and site of service for the UnitedHealthcare Community Plan of New Jersey.

Updated NYS Medicaid Perinatal Care Standards
The NYS DOH has issued new NYS Medicaid Perinatal Care Standards, which replace the previously published version.

Prior authorization changes for 2 procedures
Prior authorization changes to Lower Extremity Vascular Angiography and Endovascular Revascularization procedures.

New environmental allergen immunotherapy policy
Beginning Jan. 1, 2023, we will no longer cover home and self-administered subcutaneous allergen immunotherapy.

Updated process for prior authorization requests
As of Jan. 1, 2023, Optum will manage Individual Exchange plan prior authorizations for non-oncology medications.

Medicare: Part B step therapy prior authorization requirements
For dates of service starting Jan. 1, 2023, prior authorization is required for Part B step therapy program medications.

Oxford prior authorization requirement changes
On Jan. 1, 2023, we will make significant changes to the UnitedHealthcare Oxford plan prior authorization requirements.

New automated prior authorizations 
UnitedHealthcare Oxford plans in New York and New Jersey will offer newly enhanced features.

State news

Hurricane Ian: Support and temporary provisions in your area
Access information for specific locales, and how to update UnitedHealthcare if your practice is temporarily closed or relocated.

Minnesota Medicaid member rights and responsibilities
Minnesota Medicaid members have rights and responsibilities when engaging with us and contracted providers.

Claims denied for non-enrolled providers
Starting Sept. 1, 2022, we will deny all claims for providers who are not enrolled in the NYS Medicaid Program. 

Texas service facility NPI requirement
Starting Jan. 1, 2023, we’ll deny claims submitted without a service facility NPI.

Medicaid/HealthChoices agreement changes
Effective Sept. 1, 2022, there were changes to the MCOs serving Medicaid/HealthChoices members in Pennsylvania.

Plan and program updates

Medicare Advantage updates to incentive programs
Learn about updates to the CAHPS® and HOS survey target scores for Medicare Advantage.  

New drug added for Medication Sourcing
Access new medical specialty medication for outpatient hospitals. 

Optum Pay launches Quick Pay
Eligible Optum Pay premium users can opt in to receive ACH payments 1–2 days sooner with the new Quick Pay feature.

TrackIt. Try it. Love it.
TrackIt is your innovative, daily to-do list for items that need attention in the UnitedHealthcare Provider Portal.

Oct. 20 publication

Policy and protocol updates

Mississippi: Provider validation process change
UnitedHealthcare Community Plan of Mississippi requires the NPI number and taxonomy code for all providers on the claim.

Taxonomy codes required for Medicaid claims
For dates of service starting Dec. 1, 2021, taxonomy codes are required for all New Jersey Medicaid claims submissions.

North Carolina: Avoid denials with timely filing
Timely filing can help ensure payment to health care professionals who participate with UnitedHealthcare Community Plan.

State news

Maryland: Monkeypox vaccine pre-registration now available
The Maryland Department of Health Monkeypox Vaccination Pre-Registration System is now available.

Help your patients get timely care
The Rhode Island Department of Human Services has established appointment availability standards for Medicaid members.

Prior authorization update for abortion services
Effective Nov. 1, 2022, we will require prior authorization for several abortion CPT® codes.

Complete an OBRAF to earn an incentive
Earn incentives for your practice by completing an OBRAF for your pregnant patients who are Virginia Medicaid members.

Digital policy

Get ready: Digital submissions required in 2023
In 2023, network providers/facilities must submit claims, attachments, reconsiderations and appeals electronically.

Overpayment letters won’t be mailed after Sept. 23
Starting Sept. 23, 2022, most E&I and M&R overpayment notification letters sent by UnitedHealthcare are going paperless. View via portal, API or Direct Connect.

Appeal decision letters won’t be mailed starting Nov. 4
Appeal decision letters for most community plans to network health care professionals (primary and ancillary) and facilities in Tennessee, Virginia and Wisconsin are going paperless.  

Program and health plan updates

Updates to Individual Exchange plans for 2023
On Jan. 1, 2023, we’ll offer Individual Exchange plans in 4 new states and continue to offer them in 14 existing states.

Medicaid redetermination update
Medicaid and CHIP eligibility reviews may resume again soon. Learn how to help your patients who have Medicaid prepare.

Upcoming webinars

Prepare for Surest members in a live webinar
You’re invited to attend the Oct. 27 Surest live webinar to learn how you can prepare for members with these plans.

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