April 01, 2023

April monthly overview

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

April 1 publication

Policy and protocol updates

Medical policy updates: April 2023
Medical policy updates for April 2023 for the following plans: Medicare, Medicaid, Exchanges and commercial.

Reimbursement policy updates: April 2023
See the latest updates for reimbursement policies. 

Specialty Medical Injectable Drug program updates: April 2023
See the latest updates to requirements for Specialty Medical Injectable Drugs for UnitedHealthcare members. 

Pharmacy and clinical updates: April 2023
Access upcoming new or revised clinical programs and implementation dates for UnitedHealthcare plans.

State news

Alabama: D-SNP Coordination-of-Benefits update
UnitedHealthcare Community Plan in Alabama reimburses Medicaid-covered services using the Alabama Medicaid Fee Schedules.

Prior authorization requirement changes for radiation therapies
Effective June 1, 2023, we will require prior authorization for some outpatient radiation therapies in Louisiana.

New York: Prior authorization update
Starting on July 1, 2023, Optum® will conduct medical necessity reviews for occupational, physical and speech therapy.

Rhode Island: Claims require billing taxonomy
Starting on Jan. 1, 2023, UnitedHealthcare Community Plan of Rhode Island requires billing taxonomy codes on all claims.

Removal of certain requirements for Rhode Island 
As of June 1, 2023, we’ll no longer require prior authorization or medical necessity reviews for certain procedure codes. 

Policy change for Medicaid home health services 
Texas Medicaid changed their signature requirements for home health services.

Texas: Pharmacy prior authorization, step therapy change
Starting June 1, 2023, Optum will manage prior authorization and step therapy requests for prescription medications for Texas residents with pharmacy coverage.

Prior authorization changes

Home health review prior authorization updates
Starting May 1, 2023, we'll require prior authorization for home health services for D-SNP members in some states.

New oncology prior authorization codes for commercial plans
As of July 1, 2023, we’ll require prior authorization for some injectable chemotherapy medications in outpatient settings.

Digital updates and enhancements

Three new Smart Edits for commercial plans
On March 2, 2023, we added 3 new Smart Edits to help with claims for UnitedHealthcare commercial plan claims.

Coming soon: Faster and easier online credentialing 
Effective June, Onboard Pro makes online credentialing faster and easier, replacing RFP.

Claim letters going digital on July 7 
Starting July 7, 2023, we won’t mail Medicare Advantage claim letters to most network health care professionals/facilities.

April 20 publication

State news

California timely access requirements
You’re required to follow certain appointment availability standards for your patients in California.

Florida: Report resident status changes
Report changes for UnitedHealthcare Community Medicaid Long-Term Care members.

Prior authorization requirement changes for radiation therapies
Starting June 1, 2023, we will require prior authorization for some outpatient radiation therapies for UnitedHealthcare Community Plan members in Kentucky.

End of CHIP copayment waiver 
Effective May 12, 2023, TMHP will no longer waive copayments for CHIP, except for specific services.

Digital and paperless updates

Overpayment, appeal letters going paperless May 5
Starting May 5, Medicaid FL,KY,MD, MA, MN, MO, NJ, NY, NC, OH, PA, RI, TX, DC overpayment, appeal decision letters won't be mailed.

Best practices

Coding tips for KED quality measure
CPT® code 82044 was replaced with CPT 82043 in the NCQA HEDIS® set. See full coding set for gap closure.

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