January 01, 2023

January monthly overview

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

Jan. 1 publication

Policy and protocol updates

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

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

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

State news

Arizona Medicaid: Prior authorization and notification updates
Starting Feb. 1, 2023, we are updating the prior authorization process for occupational therapy and physical therapy.

Maryland: Support your patients through MOM
The Maternal Opioid Misuse (MOM) model helps pregnant and postpartum patients and their infants. See what it means for you.

Coverage change for Avastin 10mg
Beginning Feb. 1, 2023, UnitedHealthcare Community Plan of New Jersey will not cover Avastin 10 mg (HCPCS code J9035).

New York: Claim denials for non-enrolled providers
We have begun to deny claims submitted by providers who are not enrolled with the state Medicaid program.

Provider administered drugs prior authorization updates
Effective for dates of service starting Feb. 1, 2023, we will require prior authorization for several drugs.

Anti-emetics prior authorization change
Starting Jan. 1, 2023, prior authorization will be required for certain injectable anti-emetics.

Tennessee Medicaid: Dental benefits for adults
Beginning Jan. 1, 2023, TennCare Medicaid adult members will have dental benefits included in their health plan.

Plan and coverage changes

Medicare cost-share changes begin Jan. 1, 2023
Starting Jan. 1, 2023, we are making changes to cost-share maximums for insulin and certain adult vaccines.

Reminder of 3-day payment window policy
UnitedHealthcare commercial provider contracts adhere to the “3-day (or 1-day) payment window” policy.

Medication Sourcing drug list updates
Effective April 1, 2023, we’re updating the specialty pharmacy requirements drug list. See the changes.

CardioMEMS HF System coverage update
Effective April 1, 2023, we will require prior authorization for CardioMEMS™ HF System.

Know more about NexusACO plans
UnitedHealthcare NexusACO® plans are growing in 2023. Learn their benefits and features.

Service and tool updates

Update on Virtual Card Payment services
This article updates providers on the expected resumption of VCP payments in late second quarter 2023.

Help your patients find a network lab
Members must go to in-network labs for non-emergency care, wherever possible. See what to do if a service is not available.

Jan. 19 publication

State news

Colorado: Required training information
If you’re in-network for Colorado commercial or Individual Exchange plans, you’re required to submit training information.

Refer patients to Oxford Preferred Lab Network 
Refer your New Jersey and New York commercial Oxford patients to Oxford Preferred Lab Network for lab services.

North Carolina: Copayment applied to certain Medicaid services
Effective Jan. 1, 2023, we will apply a copayment to all Medicaid services that require one.

Ohio Medicaid: Prepare for the Next Generation launch
Changes to claim and prior authorization submissions for Ohio Medicaid Plans.

Texas Medicare: Claims process change
New claims process for Medicare Advantage patients with Southwestern Health Resources PCPs.

Plan and program changes

Outpatient Procedure Grouper mapping updates
On Jan. 1, 2023, we made changes to the current plan 2022 UnitedHealthcare Outpatient Procedure Grouper mapping.

UnitedHealthcare Community Plan: New prescription safety edits
Learn what new Concurrent Drug Utilization Review (cDUR) edits are now live for UnitedHealthcare Community Plan.

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.

Optum to manage kidney care management services
Effective Jan. 1, 2023, we’ve transferred kidney care management services from Somatus to Optum KRS.

Digital updates

Reconsideration and appeal submissions going digital 
Feb. 1, 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.

Learn about Medicare members’ rights and responsibilities 
View information regarding the rights and responsibilities of Medicare members.  

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