September 01, 2022

September monthly overview

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

Sept. 1 publication

Policy and protocol updates

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

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

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

Colorado: Request for demographic information
We’re requesting the demographic information of health care professionals in our Colorado Option Standardized Plan.

Massachusetts: Discharge planning contact
Contact the UnitedHealthcare Clinical On-Call Team for discharge planning for members at risk of homelessness.

Minnesota: Medical claim-related letters going paperless
Effective Sept. 9, 2022, we will no longer print and mail certain medical claim-related letters. 

Genetic testing codes added to prior authorization requirement
Effective Dec. 1, 2022, we’ll require prior authorization for additional CPT® codes for genetic testing.

Oral oncology prior authorization process change
Effective Oct. 3, 2022, providers will no longer need to contact Optum Rx for oral oncology prior authorization requests.  

New specialty pharmacy requirements
Beginning Dec.1, 2022, there is an oncology drug update for specialty pharmacy with the addition of Skyrizi to the drug list.


State news

By report billing required for ZOLADEX
As of April 14, 2022, you’ll need to follow the "by report" billing process for ZOLADEX®, a drug manufactured by TerSera.

Now live: Rhode Island Medicaid changes
Beginning Sept. 1, 2022, the following changes will go into effect: changes to our claims processing platform, the provider Call Center phone number will change and members will have a new Member ID number.

Washington: Clinical practice guideline updates
Review changes in clinical practice guidelines from year 2021 to 2022.

Help children get preventive care
HealthCheck is a Wisconsin Medicaid benefit that covers diagnostic and intervention services for children.

New prior authorization codes
Effective Dec. 1, 2022, we’re making changes to the prior authorization list for Individual Exchange plans.


Tools and resources

Portal: New look, plus more personalization
The UnitedHealthcare Provider Portal has a new look and can be customized to roles and preferences based on your One Healthcare ID.

Vaccination resources
You can use these resources as you help your patients stay current on their vaccinations.


Plan updates

UnitedHealthcare Medicare Advantage 2023 changes
Effective Jan. 1, 2023, Medicare Advantage is reducing some service areas and discontinuing some plans.


Sept. 22 publication

Policy and protocol updates

Indiana Medicaid: New 90-day demographic verification
Contracted health care professionals with UnitedHealthcare Community Plan of Indiana are encouraged to verify demographic data every 90 days.

Coverage extended for pregnant individuals
Medicaid coverage in Kentucky is extended to 12 months after postpartum delivery for pregnant individuals and infants.

Endometrial added to Cancer Therapy Pathways
As of Sept. 1, 2022, uterine (endometrial) will be added to our Cancer Therapy Pathways Program.

eConsults may benefit your practice
eConsults can have many benefits for your practice and patients. We reimburse for eConsult CPT codes for all plans.

Helping children with challenges adapt to school
Children in the TennCare program can get additional services while in a school setting. See how you can help.

Gold card law for prior authorization process
Texas gold card law exempts some services from prior authorization requirements.


State news

COVID-19 mitigation updates and toolkit
UnitedHealthcare Community Plan and MDHHS recommend the use of layered COVID-19 mitigation strategies for individuals.

Pennsylvania Medicaid: Important member updates
Find updates to services designed to support patients who are UnitedHealthcare Community Plan of Pennsylvania members.

Serving children and pregnant women in Texas
UnitedHealthcare provides services to children and pregnant women with health issues and health risks in Texas.

Maryland appeal and grievances submissions
UnitedHealthcare Community Plan of Maryland providers must submit appeals and grievances through the proper channels.

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

Changes to practitioner dispensing billing
Effective Sept. 1, 2022, MMC plans will deny payment to pharmacies not enrolled as a pharmacy provider for FFS Medicaid.

North Carolina Medicaid: Incentive programs
UnitedHealthcare Community Plan of North Carolina offers 2 provider incentive programs, including CP-PCPi and CP-HEPi.


Events

Virtual provider expo for Oklahoma and Texas
Join us for a provider information expo for health care professionals in Oklahoma and Texas.

Events on long-term services and supports
Attend one of our live town hall events in Texas for long-term services and supports training. See topics and locations.

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