January monthly overview
Network News is published once a month. See updates below.
January 1 publication
Policy and protocol updates
Medical policy updates
Medical policy updates for January 2026 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 Medicaid: Tribal communities reimbursed for traditional healing services
AHCCCS honors the cultural traditions of physical, mental, emotional and spiritual wellness of Indigenous tribes.
Indiana Medicaid: New prior authorization requirements for additional incontinence products
On Jan. 1, 2026, we’ll require prior authorizations for incontinence products when the service exceeds the monthly limit.
Maryland: Reminder to submit referrals with IFP claims
Avoid claim denials by including referrals with E&M and specialty service claims. Missing referrals may require an appeal.
Massachusetts MMP: Important changes for health care providers
Medicare–Medicaid Plans end Dec. 31, 2025. Members will be automatically enrolled in a new dual plan starting Jan. 1, 2026.
Michigan: New universal lead testing requirement for children
See what’s changed with Michigan’s lead testing policy for children.
Nebraska Medicaid: Knee injection coverage and attestation for single-dose drugs
Coverage ends for hyaluronan intra-articular injections. Plus, providers must attest to full use of single-container drugs.
New Jersey Medicaid: Billing guidance for sickle cell disease treatments
Access claim information and requirements in the CMS Cell and Gene Therapy Access Model and New Jersey Medicaid Guidance.
New Mexico Medicaid: Updates to gross receipt taxes reimbursement information
Effective Jan. 1, 2026, MCOs must reimburse health care providers for gross receipts taxes they pay on Medicaid services.
North Carolina Medicaid: State upholds EVV transmission requirements
Home health providers must transmit EVV data to the health plan’s EVV vendor. Know your options.
Program and health plan updates
Review the 2026 Administrative Guide
The Provider Administrative Guide for Commercial, Individual Exchange and Medicare Advantage plans is updated for 2026.
Prepare for New York City Employees (NYCE) PPO plan members
Ensure your practice is aware of the plan features, network distinctions and support resources.
New DME process for select members in multiple states
On April 1, 2026, you’ll use Synapse Health for durable medical equipment orders in certain states.
Medicare plan updates
Medicare: New non-formulary medication request process
On Jan. 1, 2026, all non-formulary requests must include progress notes. Consider formulary options first.
Medicare Advantage update: PCP referrals required for specialist visits
On Jan. 1, 2026, PCP referrals are required for specialist visits under most UnitedHealthcare Medicare Advantage HMO/HMO-POS plans.
Prior authorization updates
Improved prior authorization process for sacroiliac joint injections
On April 1, 2026, medical necessity review won’t be required for sacroiliac joint injection prior authorizations.
New genetic and molecular codes announced for prior authorization
Beginning April 1, 2026, new AMA procedure codes for genetic and molecular testing will require prior authorization.
New radiology and cardiology prior authorization codes
On April 1, 2026, we’ll add advanced imaging and cardiology codes to radiology and cardiology prior authorizations.
Digital platform updates
Transfer large files with our new Secure File Transfer Protocol
SFTP securely sends files that are too large to send with other methods.
