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June 01, 2024

June monthly overview

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

June 1 publication

Policy and protocol updates

Medical policy updates
Medical policy updates for June 2024 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

Colorado: No referrals required with HMO Open Access
As of Jan. 1, 2024, all of our Medicare HMO H0609 plans no longer require referrals.

Sept. 1: Electronic reconsideration and appeal submissions required
Health care professionals must submit Medicaid medical reconsiderations and appeal submissions electronically in MN and VA.

New Jersey: Do your patients need to renew their Medicaid coverage?
Your NJ FamilyCare (Medicaid) patients may need to renew their coverage. If not, they could lose their eligibility.

New Jersey Medicaid: Claims reminder for nutritionist services
Are your claims for nutritionist services being denied? See how to check the maximum frequency allowed per CPT® code.

North Carolina Medicaid: EP modifier requirement for EPSDT services
Avoid denied claims for Early and Periodic Screening Diagnostic Treatment services by properly using the EP modifier.

Texas Medicaid: 25 in-person meetings coming to you soon
UnitedHealthcare Community Plan of Texas is hosting several town hall meetings regarding service area expansion.

Sept. 13: Several documents going paperless
VCP statements, and overpayment and claim letters going digital for Virginia Medicaid members.


Prior authorization updates

Surest plans: Change to oncology prior authorization process
As of July 1, 2024, prior authorization requests for Surest plans and Surest Flex plans must be submitted using Optum CGP.


UHC Provider Portal changes

Updates required: Portal access methods are changing
To enhance data security, UnitedHealthcare Provider Portal and specialty portal users will be required to make One Healthcare ID sign-in and recovery updates by summer 2024.

Now available: New and enhanced claim submission process features
We’ve updated our claims section to make it easier for you to understand where in the process a claim may be.


Plan and policy news

RMHP Individual Exchange plans to align with hospital reference lab protocol
Effective Sept. 1, UnitedHealthcare Hospital Reference Lab Protocol will apply to RMHP Individual Exchange plans.

View claims submission information for APWUHP High Option members using the UnitedHealthcare network
Starting Jan. 1, 2024, American Postal Works Union Health Plan High Option members will use the UnitedHealthcare network.

LCD Guidance for Skin Substitutes
Medicare does not have an NCD for non-porcine based skin substitutes. View our Medicare Advantage Coverage Summary.

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