May 01, 2023

May monthly overview

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

May 1 publication

Policy and protocol updates

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

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

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

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

State news

Kentucky Medicaid: Home infusion requirements
Providers delivering home infusion care must register as both a pharmacy and DME provider.

New medications require prior authorization
Prior authorization is required for these health care professional-administered medications.

Maryland: Preventing health care fraud and abuse
See examples of health care fraud and abuse and get contact information for reporting incidents. Reports are confidential.

Prior authorization changes

New home health prior authorization review process
Starting Aug. 1, 2023, you’ll need to request prior authorization for home health visits after the SOC visit through naviHealth.

Resources and tools

Explore the new gastroenterology prior authorization web page 
Visit our new gastroenterology prior authorization page for helpful information and FAQ.

Digital updates and outreach

Starting Aug. 4, claim letters are going paperless
Starting Aug. 4, 2023, we won’t mail commercial plan claim letters to most network health care professionals/facilities.

2023 in-home screening outreach underway
Eligible UnitedHealthcare commercial plan members may receive in-home screening outreach throughout May and June.

Annual commercial plan federal audit
You may be contacted for a federally required medical record audit.

Miscellaneous news

Telehealth documentation requirements
As a reminder, a patient visit performed through telehealth should be documented to the same level as an in-person visit.

Enroll to receive Oxford claim payments by ACH May 10
Oxford providers must enroll to receive claim payments by ACH before May 10, 2023.

COVID-19 PHE ends on May 11, 2023
The COVID-19 national public health emergency (PHE) will end on May 11, 2023. See what’s changing.

May 18 publication

State News

Paperless updates for Michigan Medicaid
Effective June 2, 2023, we will no longer mail a number of key medical claim-related letters and documents for most UnitedHealthcare Community Plans in Michigan.

Tennessee: New ASH claim billing requirements
Effective July 1, 2023, claims for certain ASH procedures will require specific information and a completed ASH form.

Texas Medicaid: Updated ICD-10 codes for dialysis
Effective June 15, 2023, we’ll update the clinical criteria for SGLT2 agents.

Washington Medicaid digital updates
Effective June 2, 2023, we will no longer print and mail appeal decision and overpayment letters for most UnitedHealthcare Community Plan health plans.

Tools and resources

Behavioral health resources for medical providers
Use these behavioral health resources to help you provide care for UnitedHealthcare commercial plan members.

Helping you coordinate patient care
UnitedHealthcare has care coordination programs for controlled substance monitoring, maternity support and more.

Pennsylvania Medicaid: Preferred supplies list
We encourage you to choose items listed on this preferred drug list when treating your patients.

Other news

The 2022 Quality Improvement survey results are in
See how members and health care professionals rated us in various areas of quality.

Explore 2023 member rights and responsibilities information
Review helpful information relating to 2023 member rights and responsibilities.

Changes to The Empire Plan on July 1, 2023 
Most enrollees in The Empire Plan will experience changes to their benefits beginning July 1, 2023. Learn what’s changing.

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