September 01, 2023

September monthly overview

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

September 1 publication

Policy and protocol updates

Medical policy updates
Medical policy updates for September 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

Oxford Preferred Lab Network
You can help reduce patients’ out-of-pocket costs by referring them to the Oxford Preferred Lab Network.

North Carolina: RJ Health crosswalk not required
As of Aug. 1, 2023, you’re no longer required to match HCPCS and NDC for claims using the crosswalk table from RJ Health.

Refer at-risk patients to nutritional program
Help change the nutritional health of your patients diagnosed with serious illnesses. Learn how.

Process and policy changes

Genitourinary Pathogen medical policy ending
Genitourinary Pathogen Nucleic Acid Detection Testing medical policy and related prior authorization requirements ending.

New Empire Plan address for contractual notices
Send required written notices to Empire Plan’s updated mailing address starting Sept. 1.

Prescription drug notices

Discontinuation of Flovent HFA and Flovent Diskus
GlaxoSmithKline has announced the discontinuation of Flovent Diskus and Flovent HFA. See preferred covered alternatives.

Digital updates

Dec. 1: Digital pre-service appeal submissions required
Network commercial and Medicare Advantage health care professionals must submit medical pre-service appeals electronically.

Overpayment letters, VCP statements going paperless Nov. 3
Starting Nov. 3, overpayment letters and virtual card payment statements for TN Medicaid won’t be mailed.

September 21 publication

State news

California: Screen maternal patients for mental health
California passes bill to support pregnancy and postpartum mental health screening and treatment.

Colorado: Rocky Mountain Health Plans medical criteria is available
View the medical guidelines and criteria Rocky Mountain Health Plans uses to help make determinations on prior authorizations and other benefit decisions.

Texas Community Plan: Complete your education requirements online
We’re offering a free, online UTI course for all Texas health care professionals.

Texas Medicaid: New drug prior authorizations
Effective Sept. 17, 2023, you must request prior authorization for Aubagio®, Vascepa®, Austedo® and Gattex® medications.

Wisconsin Medicaid: EVV updates for home health care
Wisconsin DHS is currently developing a plan for electronic visit verification of certain home health care service codes.

Wisconsin Community Plan: Some payment documents going paperless Oct. 6
Beginning Oct. 6, 2023, we’ll no longer mail some documents found in the Payment Documents folder within Document Library in the UnitedHealthcare Provider Portal.

Hispanic heritage month

Make a difference this Hispanic heritage month 
Update your profile to let patients know your practice has Spanish-speaking health care professionals.

Service area changes

Medicare Advantage service area changes
Find more information on service area changes for Medicare Advantage plans.

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