November 01, 2023

November monthly overview

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

November 1 publication

Policy and protocol updates

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

Reimbursement policy updates
See the latest updates for reimbursement policies. 

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

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

State news

Arizona Community Plan: Pharmacy policy updates effective Dec. 1
Effective Dec. 1, 2023, we’re moving coverage for 2 medications and a therapy class from Optum® Infusion to Optum Specialty.

Colorado Medicaid: Genetic testing covered for prostate cancer
Health First Colorado covers genetic testing for Medicaid members with prostate cancer, with approved prior authorization.

Radiation therapy prior authorization requirement
UnitedHealthcare Medicare Advantage will require outpatient radiation therapies prior authorization.

Massachusetts Medicaid: VCP statements going paperless Feb. 2
Starting Feb. 2, we’ll no longer mail VCP statements to medical providers serving Community Plan members in Massachusetts.

Nebraska Medicaid: Billing updates for JW modifier
Effective Oct. 1, 2023, Nebraska Medicaid will no longer reimburse for discarded drugs billed on outpatient hospital claims.

New Jersey: Medicaid claim letters going paperless
As of Feb. 2, 2024, Medicaid claim letters won’t be mailed in New Jersey.

Texas Medicaid: Earn 5.5 hours of free CE 
UnitedHealthcare Community Plan of Texas and the American College of Lifestyle Medicine (ACLM) are partnering to offer 5.5 hours of free CE.

Washington Medicaid: VCP statements, claim letters going paperless
As of Feb. 2, 2024, Medicaid VCP statements and claim letters won’t be mailed in Washington.

Prior authorization changes

Prior authorization reduction equals nearly 20 percent of overall volume
Starting Sept. 1, 2023, we’ll begin a 2-phased approach to eliminate the prior authorization requirement for many procedure codes.

Updated prior authorization requirement for genetic and molecular codes
As of Jan.1, 2024, we’ll require prior authorization/advance notification for new genetic and molecular procedure codes.

Plan and program updates

Network change for some APWUHP members
Starting Jan. 1, 2024, American Postal Workers Union Health Plan High Option members will use the UnitedHealthcare network.

Medicaid PRIME: Update prior authorizations or prescriptions to continue member care
Rocky Mountain Health Plans (Medicaid PRIME) and Child Health Plan Plus (CHP+) prescriptions require authorization.

Feb. 1: Reconsideration, appeal submissions going digital-only
Medicaid health care professionals must submit medical reconsideration and appeal submissions electronically in MI, MO, NJ, NC, TN, WA and WI.

Changes for The Empire Plan starting Jan. 1, 2024
Some enrollee groups will see benefit changes in January.

Resource and tool enhancements

Coming soon: Onboard Pro capabilities for hospitals and facilities
In December, health care facilities in all states will use Onboard Pro to start the credentialing and contracting process.

Prescription drug list updates

Jan. 1, 2024, updates to Individual Exchange plans PDLs
Effective Jan. 1, 2024, we're making changes to the prescription drug list (PDL) for UnitedHealthcare Individual Exchange plans.

November 16 publication

State news

Michigan: Learn how cultural diversity helps improve care
We have several cultural competency trainings available to you and your staff.

Ohio: Make your Provider Network Management module updates to avoid claim denials
It is imperative that providers update all address and affiliation information in the PNM so that claims payments, provider directories and network adequacy measurements are not negatively impacted.

Texas: View the latest TraumaTALKS course
Explore the latest TraumaTALKS training course: An Introspective Look at Trauma and the Need for Self-Care.

Digital updates

Dec. 1: Digital pre-service appeal submissions required
Beginning Dec. 1, 2023, you’ll be required to submit medical pre-service appeals electronically. No more wasting time tracking down lost or delayed mail. 

Health plan updates

Peoples Health is moving to UnitedHealthcare systems
Learn about the processes and resources Peoples Health providers may need to know before Jan. 1.

Network change for some APWUHP members
Starting Jan. 1, 2024, American Postal Workers Union Health Plan High Option members will use the UnitedHealthcare network.


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