February 01, 2023

February monthly overview

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

Feb. 1 publication

Policy and protocol updates

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

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

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

State news

Michigan: Prior authorization updates for provider-administered drugs
Effective for dates of service starting May 1, 2023, we will require prior authorization for certain medications.

Minnesota: Extended peer-to-peer review request window
Participating Minnesota hospitals now have 7 business days to request a peer-to-peer review of determinations.

Nebraska: Continuous glucose monitoring updates
On Jan. 1, 2023, we began covering continuous glucose monitoring (CGM) devices for UnitedHealthcare Community Plan members.

Texas: Pediatric formula prior authorizations
Effective March 1, 2023, UnitedHealthcare Community Plan resumes prior authorization requirements for pediatric formula.

Wisconsin Medicaid registration requirements 
You must be enrolled with Medicaid to get reimbursed for providing services to eligible patients. Find out how.

Wisconsin Medicaid claims: Field requirements
Medicaid claims will be denied for incorrect taxonomy codes and if the required fields on forms are wrong or missing.

Tools and resources

Pharmacy prior authorization resources
Use UnitedHealthcare prior authorization resources to help your patients avoid medication issues and delays.

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

Program and plan updates

Medicare: Part B Step Therapy program updates
Starting Feb. 1, 2023, Feraheme® will move to a preferred status for some plans.

CPT III code policy update starting April 1
Starting April 1, 2023, we will require prior authorization for most CPT® III codes.

Over 600k members to receive new ID cards
Article highlighting number of members, plans and member ID changes tied to new claims platform migration on Feb. 1.

New home health prior authorization process
Request prior authorization for SOC visits through naviHealth.

New therapies for Cancer Therapy Pathway program
Chronic myeloid leukemia, prostate, esophageal and gastric added to Cancer Therapy Pathways Program.

CPT® is a registered trademark of the American Medical Association.

Feb. 16 publication

State news

Florida: Save the date for 2023 training events
Informational discussions offered exclusively for Florida health care professionals.

Michigan Medicaid reimburses for doula services
Medicaid now reimburses for doula services. Learn more about the program and see how you can get involved.

Missouri Medicaid: New breast pump vendor
UnitedHealthcare Community Plan of Missouri is using a new breast pump vendor.

Americans with Disabilities Act compliance
ADA treatment plan for patients using stretchers and wheelchairs.

Plan and program changes

Nokia employees now have Surest plans
Learn how to recognize and support Surest plan members, including Nokia employees who are now covered by the plans.

Medicare: Member ID card barcodes
See guidance on new UnitedHealthcare Medicare Advantage plan UCards.

Changes to Designated Diagnostic Provider network
Oregon Designated Diagnostic Provider network no longer includes large group plans.

Medicaid redetermination update
On April 1, 2023, states can begin redeterminations to decide if individuals qualify for coverage through Medicaid or CHIP.

Digital updates

Update your email notifications in one spot
New! Update email preferences for Document Library and TrackIt in Profile & Settings in the portal.

Ambulance claim submission process improvements
An issue that prevented ambulance providers from completing a claim entry has been fixed as of Dec. 13, 2022.

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