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December Policy and protocol update overview
Nov. 14, 2019
12/2019: UnitedHealthcare Preferred Lab Network Inviting Labs to ApplyThe annual application process for admission to the UnitedHealthcare Preferred Lab Network is now open.
Nov. 14, 2019
12/2019: OptumRx Retiring Fax Numbers Used for Pharmacy Prior Authorizations on Dec. 31OptumRx® is going digital and will retire fax numbers used to submit pharmacy prior authorization requests on Dec. 31, 2019.
Nov. 22, 2019
12/2019: Enhancements Help Streamline Prior AuthorizationWe’ve made enhancements to our Prior Authorization and Notification tool on Link to improve the online submission process.
Nov. 14, 2019
12/2019: New Online Peer-to-Peer Scheduling Request Form Available In Mid-DecemberTo help simplify the peer-to-peer scheduling process, we’ve updated our Peer-to-Peer Scheduling Request form with the ability to submit directly from the website.
Nov. 22, 2019
12/2019: UnitedHealthcare Will Reward Care Providers through Cancer ProgramThe new Cancer Therapy Pathways Program promotes the use of evidence-based and cost-effective regimens.
Dec. 19, 2019
01/2020: Prepare Today for Patients with Bind On-Demand Health InsuranceOn Jan. 1, 2020, Bind on-demand health insurance will be available to all UnitedHealthcare employer groups across the nation.
Dec. 20, 2019
01/2020: HEDIS® 2020 Medical Record Collection OverviewBeginning in January 2020, we may contact you to request member-specific medical records.
Dec. 19, 2019
01/2020: Now Available: Individual Health Record™We want to improve the health of every individual with UnitedHealthcare’s Individual Health Record.
Sept. 17, 2020
01/2020: UnitedHealthcare NexusACO® Benefit Plans Will Expand Access in 2020Membership in the UnitedHealthcare NexusACO benefit plans is continuing to grow. Starting Jan. 1, 2020, even more members will have access to the UnitedHealthcare NexusACO plans.
Sept. 23, 2020
01/2020: Bringing You Smart Edits in the New YearTo support care providers in our network, UnitedHealthcare offers a claims optimization tool called Smart Edits.
Apr. 7, 2020
Get Ready for the CAHPS/HOS SeasonYour patients may be participating in a survey initiative that may impact your care and interactions with them.
Feb. 2, 2020
MA Benefit Plans Expanding in 2020This year our Medicare Advantage plans are expanding across 43 states, potentially boosting the impact you can have on patients near you.
Feb. 7, 2020
Hospital Reference Lab ProtocolChanges are being made May 1, 2020 to UnitedHealthcare commercial non-patient lab reimbursement requirements.
January 23, 2020
Prior Authorization Submission EnhancementsYou can do more, faster with the new enhancements to our Prior Authorization and Notification (PAAN) tool on Link.
January 23, 2020
New Requirements for Percutaneous PFO ClosureEffective May 1, 2020, we’re introducing a required notification/prior authorization process for Percutaneous Patent Foramen Ovale (PFO) Closure for UnitedHealthcare commercial members.
Feb. 2, 2020
Enhance the Way You Prescribe MedicinePreCheck MyScript® (PCMS) is a prescription price tool to help save time, reduce administrative tasks and may lower costs for your patients.
Feb. 28, 2020
Your Area of ExpertiseLearn if an Area of Expertise has been added to your profile on UHCprovider.com. This helps patients find medical care providers who have experience, skills, or training in a particular area.
Feb. 28, 2020
Avella to Provide Infertility MedicationStarting March 1, 2020, all infertilely medication will be designated to Avella Specialty Pharmacy for OptumRx® and UnitedHealthcare Community Plan and commercial members.
Feb. 28, 2020
Additions to Cancer Therapy PathwaysMelanoma and colorectal cancers are now included in our Cancer Therapy Pathways program. Learn about participating plans, opportunities for rewards, training and more.
Feb. 28, 2020
Update to 2019–2021 Credentialing PlanEffective June 1, 2020, we have made updates to our 2019 – 2021 Credentialing Plan regarding the requirements for facilities that include either accreditation or a site visit.
Feb. 28, 2020
Electronic Payment Solutions Rolling Out in 2020Throughout 2020, we will launch initiatives to replace paper checks with electronic payments. Learn about your electronic payment options and opportunities.
Feb. 28, 2020
Prior Authorization and Notification Requirement UpdatesWe’re making changes to certain advance notification and prior authorization requirements. See the updated links and 2020 Summary of Changes.
Apr. 28, 2020
Coronary CTA Reimbursement UpdateYou can learn more about Coronary Computed Tomographic Angiograms (CTA) that are eligible for reimbursement in certain situations.
Apr. 24, 2020
COVID-19 Treatment UpdateLearn more about how member cost sharing for the treatment of COVID-19 is being waived until May 31, 2020.
Apr. 29, 2020
Genetic and Molecular Prior AuthorizationPrior authorization for genetic and molecular testing performed in an outpatients setting will now be required for California, Hawaii, Kansas, Nebraska, Ohio and Wisconsin.
Nov. 2, 2021
Prior Authorization and Site of Service ReviewsBeginning Aug. 1, 2020, Iowa will be in scope with specific outpatient surgical codes we announced in November 2019.
May 27, 2020
Care ManagementLearn about what a United Healthcare Community Plan case manager can provide for your patients.
May 29, 2020
Catheter Ablation for Atrial FibrillationAdditional CPT codes will be added to the prior authorization process for cardiac ablation for atrial fibrillation.
May 29, 2020
Genetic and Molecular Prior Authorization UpdateYou can review changes for prior authorization requirements for genetic and molecular testing codes for outpatient settings for commercial members.
May 27, 2020
Go Paperless With Document VaultBeginning Sept. 1, 2020, claims acknowledgement letters will be paperless.
Nov. 17, 2020
Laboratory Test Registration Requirement Coming SoonLearn more about the laboratory test registration requirement that is coming for free-standing and outpatient hospital laboratory providers.
May 26, 2020
Lower Extremity Vascular InterventionsMedicare Advantage and Community Plan members will require prior authorization for select codes related to lower extremity vascular interventions starting in September.
May 27, 2020
Oxford Health Plan Prior Authorization UpdateEffective July 1, 2020, Oxford Health Plan will have updates to their prior authorization and advanced notifications requirements.
Aug. 31, 2020
Policy, Protocol and Program Delays (Full List)This is the complete list of delays communicated in the May and June 2020 Network Bulletin.
June 23, 2020
3rd Quarter 2020 Preferred Drug List UpdateSee what’s changed for this quarters preferred drug list.
May 26, 2021
Oxfordhealth.com Provider Portal Login ChangeSee the login change being made to Oxfordhealth.com.
June 30, 2020
Preferred Lab Network ExpansionSee the latest additions to our Preferred Lab Network.
Nov. 19, 2020
Prior Authorization and Site of Service ReviewsUtah will be excluded from some prior authorization requirements and site of service medical necessity reviews.
June 29, 2020
Retiring Admission Notification Fax NumbersReview your electronic options as fax numbers are retired.
June 25, 2020
Social Determinants of Health (SDoH) ProtocolDocumenting SDoHh data using ICD-10 diagnostic code(s) is now needed.
Oct. 8, 2020
New, Streamlined Link Experience Launching in JulyWe’re creating a more streamlined Link experience.
July 31, 2020
Easy Access to Your Payments with Direct DepositWe are phasing out paper payments, providing you with quick and easy electronic payments.
July 31, 2020
Cancer Therapy Pathways Program OpportunitiesSee that latest additions to the Cancer Therapy Pathways program.
July 31, 2020
Change to Claim Denial LettersYour claim denial letters will be consolidated, starting in November.
July 31, 2020
Provider Data Accuracy RequirementsIf you are contracted with us, you must verify and attest that your practice data and demographic information is accurate every 120 days.
July 31, 2020
More Admission Notification Fax Numbers RetiringReview your electronic options and see the complete list of retiring fax numbers.
Aug. 25, 2020
Faster and Easier Online CredentialingIntroducing Onboard Pro, our new and improved credentialing tool.
Sept. 14, 2021
Out-of-Network Outpatient Benefit UpdateThere are new requirements around using out-of-network laboratories, dialysis centers and durable medical equipment (DME) providers.
July 31, 2020
UnitedHealth Premium® Program Details Now AvailableLearn more about UnitedHealth Premium designation and key dates.
Nov. 19, 2020
Prior Authorization and Site of Service ReviewsSee the expanding requirements for certain surgical procedures.
July 31, 2020
New Prescription Safety EditsLearn what new Concurrent Drug Utilization Review (cDUR) edits are rolling out to pharmacies across the country.
July 31, 2020
New Type of Smart EditsLearn more about Smart Edits so you can make the most of this claims processing tool.
Oct. 15, 2020
Texas Prior Authorization UpdateTexas will adopt WellMed's prior authorization list, in some cases, for United Healthcare Medicare Advantage plans.
Aug. 31, 2020
Accessing Member Rosters Now Online OnlyLearn more about CommunityCare tool and how you can see the member roster online.
Aug. 31, 2020
Billing Improvement for Multiple Home Health VisitsPerforming three key steps to improve the payment process when billing for multiple home health visits just got easier.
Aug. 31, 2020
New Inhaled Nitric Oxide Medical PolicyFlorida will soon be in scope for the Community Plan New Inhaled Nitric Oxide Medical Policy.
Aug. 31, 2020
Genetic and Molecular Prior Authorization UpdateThis update is for Kansas and Ohio UnintedHealthcare Community Plan.
Aug. 31, 2020
Medicare Advantage Service Area Reductions 2021Annual evaluations for Medicare Advantage plans may lead to service area reductions and plan terminations.
Sept. 21, 2021
New York Payment Policy ChangeSee that latest editions to the Cancer Therapy Pathways program.
Aug. 31, 2020
Prior Authorization and Site of Service ReviewSome prior authorization and site of service reviews implementation dates are being delayed.
Nov. 19, 2020
Prior Authorization and Site of Service Review UpdateSome prior authorization and site of service reviews implementation dates are being delayed.
Aug. 31, 2020
Retiring Admission Notification Fax Number UpdateNew electronic processes for Community Plan of Rhode Island newborn notifications and Community Plan of Washington Exception to Rule requests.
Aug. 31, 2020
More Streamlined Link Coming This FallTrackIt and referralLink will be added to your streamlined Link experience beginning this fall.
Aug. 31, 2020
Utah PRAs to Go PaperlessUtah provider payments for paper provider remittance advice (PRA) will no longer be printed and mailed.
Sept. 24, 2020
4th Quarter 2020 Preferred Drug List UpdateUnitedHealthcare Community Plan’s Preferred Drug List (PDL) is updated quarterly by our Pharmacy and Therapeutics Committee.
Sept. 29, 2020
All Savers® Alternate Funding Plans UpdateLearn more about the name change rolling out later this year.
Sept. 29, 2020
Cancer Therapy Pathways Program OpportunitiesSee what new pathway has been added to this program.
Sept. 28, 2020
Cancer Therapy Prior Authorization UpdateOutpatient Injectable Cancer Therapy Prior Authorization requirements are being updated.
Sept. 30, 2020
Case and Disease Management ProgramsThese case and disease management programs are here to support you.
Sept. 29, 2020
New (ED) Professional (E/M) Coding Policy UpdateThe implementation date for medicare and commercial plans of the Emergency Department (ED) Professional Evaluation and Management (E/M) Coding Policy have been delayed.
Oct. 7, 2020
Dual Complete: Members Matched with a NavigatorThe UnitedHealthcare Dual Complete® plan will now pair our members with a Navigator.
Sept. 29, 2020
Exchange Plans Prior Authorization InformationReview this important information about Prior Authorization submission for our new Exchange Plans.
Sept. 30, 2020
New Exchange Plans ResourcesReview important resources for the exchange plans launching in January 2021.
Sept. 29, 2020
Genetic and Molecular Prior Authorization UpdateSee what codes are being suspended from prior authorization and notification requirements.
Feb. 10, 2021
Hospital Policy Requirement ChangesIn 2021, we are updating the requirements for our hospital discharge, observation stay and emergency department notifications policy.
Sept. 28, 2020
Medicare Member Rights and ResponsibilitiesYou can share this information with your patients who are our members.
Sept. 28, 2020
Network Bulletin PDF Format RetiringAll your Network Bulletin updates are online at UHCprovider.com/networknews.
Sept. 28, 2020
New York Epidural Reimbursement UpdateLearn more about what is changing to better align with state guidelines.
May 21, 2021
Online Behavioral Health ResourcesThere is online information for medical clinicians treating depression, substance use disorders and ADHD.
Sept. 29, 2020
Facility Reimbursement Policy EnhancementThe current policy is expanding in November 2020.
Sept. 29, 2020
Prior Authorization and Site of Service UpdateLearn how we are expanding our requirements colonoscopy procedures.
Apr. 16, 2021
Radiology and Cardiology Urgent Request UpdateUrgent requests for Radiology and Cardiology prior authorization and notification are getting easier.
Sept. 28, 2020
Radiology Program Procedure Code ChangesSee what codes now require prior authorization.
Sept. 29, 2020
Tecartus Prior Authorization RequirementLearn more about prior authorization requirements for Chimeric Antigen Receptor T-cell (CAR-T) Therapy.
Sept. 29, 2020
2021 Telehealth Policy UpdatesPolicy modifications for 2021 are making some members eligible for more telehealth services.
Sept. 29, 2020
2021 Telehealth Service RequirementsGet more information about telehealth requirements for 2021.
Oct. 29, 2020
Diagnosis and Treatment of ADHDYou can review these resources to help you diagnose ADHD.
Dec. 31, 2020
Clinical Fax Number Retirement on Feb. 1, 2021As fax numbers retire, we have online tools to help support your requests.
Oct. 29, 2020
Computed Tomography Site of Service UpdateImportant update about site of service reviews.
Oct. 29, 2020
Credentialing Plan 2021–2023 Summary of ChangesYou can see some of the key updates we are making in 2021.
Nov. 11, 2020
Important Exchange Plan ResourcesMore information is available regarding the Exchange plans launching in 2021.
Oct. 29, 2020
Lab Test Registration Requirement — Delay and Scope UpdateThe Laboratory Test Registration requirement is delayed for free standing and outpatient hospital lab providers.
January 12, 2021
Leuprolide Acetate Requires Prior AuthorizationLearn more about where and when prior authorization will be required.
Oct. 29, 2020
Medicare Advantage 2021 Benefit Plan ExpansionSee where you can find Medicare Advantage plans in 2021.
Oct. 29, 2020
Treatment for Members with Substance Use DisordersLearn more about treatment for substance use disorder.
Nov. 30, 2020
Arkansas – Hospital Policy Requirement ChangesFor Arkansas, this requirement does not go into effect until March 1, 2021.
Nov. 30, 2020
Cardiac Rehabilitation UtilizationLearn about the benefits of referring your patients and cost-share changes.
Nov. 30, 2020
Digital Tools Help Members Find YouKeeping your information up-to-date makes a difference.
Nov. 30, 2020
Laboratory Test Registration Requirement – Delay UpdateSee what’s new with our lab test registration protocol.
Oct. 12, 2021
Malpractice Insurance Requirements Changing in 2021Minimum coverage amounts are increasing for credentialing and recredentialing requirements
Mar. 4, 2021
New Referral Requirements for Our Medicaid Plans - New YorkYou can learn more about what will be required.
Nov. 30, 2020
Prior Authorization and Site of Service Review UpdateNov. 30, 2020
Drug List Update – Specialty PharmaciesYou can see our expansion of the requirement to use participating specialty pharmacies for certain medications.
Nov. 30, 2020
Updated 2021 E/M Reimbursement PolicyYou have access to the updated policy and coding support tools.
Nov. 30, 2020
Utah Transition to Digital PRAs PostponedUtah from print and mail to digital solutions will be postponed to Feb. 1, 2021.
January 1, 2021
Clinical Fax Number Retirement on Feb. 1, 2021As fax numbers retire, we have online tools to help support your requests.
January 1, 2021
Connecticut: Appointment Standards for Commercial PlansPlease review the standards for appointment access and after-hours care, which are aligned with the state of Connecticut's access requirements.
January 1, 2021
New EMR/EHR Preferred Lab Network RequirementYour EMR/EHR needs to integrate with our Preferred Lab Network.
January 1, 2021
Shared Services Updates for GEHAGovernment Employees Health Association (GEHA) members in certain states will now have access to the Choice Plus network of providers.
January 1, 2021
Genetic and Molecular Lab Testing Prior Authorization ExpansionWe will require prior authorization/notification for additional CPT codes.
January 1, 2021
Louisiana 2021 Pharmacy Network OptimizationOn Jan. 15, 2021, UnitedHealthcare Community Plan in Louisiana will introduce a new pharmacy network.
January 1, 2021
Maryland: Appointment Standards for Commercial PlansPlease review the standards for appointment access and after-hours care, which are aligned with the state of Maryland's access requirements.
January 1, 2021
Medicaid Preferred Drug List UpdatePDL changes will be effective Jan. 1, 2021 for select UnitedHealthcare Community Plans.
January 1, 2021
Mental Health Referral Requirements Change for Mid-AtlanticEffective Jan. 1, 2021, referrals from primary care physicians (PCP) for routine behavioral health services, including both mental health and substance abuse, will no longer be required.
January 1, 2021
Medical Policy Update Bulletins: January 2021You can review the medical policy update bulletins for our various health benefit plans.
January 1, 2021
New Jersey’s Obs Can Enroll For Installment Payments NowComplete and return the Maternity Installment Payments Election form
January 1, 2021
New York Medicaid Prior Authorization Requirements OrthoticsEffective April 1, 2021, new codes will be added to the Prior Authorization List.
January 1, 2021
Outpatient Procedure Grouper Mapping UpdateCode updates are now available for 2021.
January 1, 2021
Radiation therapy prior authorization updateReview this update about prior authorization coverage for commercial members.
January 1, 2021
Reimbursement Policy Update Bulletins: January 2021You can review the reimbursement policy update bulletins for our various health benefit plans.
January 1, 2021
Prior Authorization Requirement for Synagis® and Xolair®Effective April 1, 2021, you’ll be required to submit a prior authorization if you plan to bill for Synagis and Xolair on the medical benefit for a UnitedHealthcare Community Plan member in California or New York.
January 1, 2021
2021 Telehealth Policy UpdatesSee updates and learn about training with billing guidance.
Feb. 1, 2021
Arizona: Evidence-based guidelines transitionEffective May 1, 2021, UnitedHealthcare Community Plan of Arizona will be transitioning our evidence-based clinical care guidelines.
Feb. 1, 2021
Exchange plan prior authorization updatesEffective April 1, 2021, prior authorization will be required for certain stereotactic body radiation therapy and stereotactic radiosurgery services for Exchange plan members in Arizona, Maryland, North Carolina, Oklahoma, Tennessee, Virginia and Washington.
Feb. 1, 2021
UnitedHealthcare is transitioning to InterQual criteriaUnitedHealthcare will transition to InterQual criteria for all benefit plans effective May 1, 2021.
Feb. 1, 2021
Maryland: Prior authorization requirements for Cinryze®, Spinraza® and Zolgensma®Effective May 1, 2021, prior authorization will be required for Cinryze, Spinraza, and Zolgensma for UnitedHealthcare Community Plan members in Maryland.
Feb. 1, 2021
Get more from your Network BulletinIf you’re used to forwarding the Network Bulletin on to your staff members, save yourself a step and subscribe your whole team. They can receive their own personalized Network Bulletin email, helping your practice to save time, receive important information faster and help relieve administrative burden.
Feb. 1, 2021
Medical Policy Update Bulletins: February 2021You can review the medical policy update bulletins for our various health benefit plans.
Feb. 1, 2021
February 2021 Network Bulletin OverviewThe February Network Bulletin includes updates for medical and reimbursement policy updates along with SNF Consolidated Billing Requirements for Medicare, cDur safety edits and more.
Feb. 1, 2021
New York: Correction – Payment Policy changeIn a September 2020 Network Bulletin article -- New York Payment Policy Change -- we incorrectly said CPT® code revisions to the New York Non-Covered Code Payment Policy applied to UnitedHealthcare Community Plan Essential Plan (EP).
Feb. 1, 2021
New prescription safety editsTo help increase patient safety and prevent abuse and fraudulent activity, UnitedHealthcare Community Plan is continuing to implement Concurrent Drug Utilization Review (cDUR) safety edits.
Feb. 1, 2021
Reimbursement Policy Update Bulletins: February 2021You can review the reimbursement policy update bulletins for our various health benefit plans.
Feb. 1, 2021
Specialty Medical Injectable Drug Program Updates: February 2021Monthly update for the Specialty Medical Injectable Drug Program Bulletin.
Feb. 1, 2021
Skilled nursing facility consolidated billing requirements for Medicare Advantage plansSkilled nursing facilities (SNF) are required to use consolidated billing when submitting claims for post-acute inpatient SNF admissions for UnitedHealthcare Medicare Advantage members.
Feb. 1, 2021
Utah: Prior authorization and clinical letters will no longer be mailedEffective May 1, 2021, we will no longer print and mail paper medical prior authorization and clinical letters to in-network health care professionals and facilities in Utah.
Feb. 1, 2021
VA CCN Provider Manual updatesRoutine updates will be made to the 2021 VA CCN Provider Manual in January, April, July and October.
Mar. 1, 2021
Electronic payments required for UnitedHealthcare Community PlansUnitedHealthcare is launching initiatives to replace paper checks with electronic payments throughout 2021. We’ll no longer be sending paper checks for provider payment in accordance with applicable laws.
Mar. 1, 2021
Exchange plans: Prior authorization updateAdditional prior authorization and notification requirements for Exchange plans launched January 1, 2021.
Mar. 1, 2021
Kansas: new outpatient injectable drug requirementsEffective June 1, 2021, for UnitedHealthcare Community Plan of Kansas members prior authorization will be required for certain drugs.
Mar. 1, 2021
Medical Policy Update Bulletins: March 2021You can review the medical policy update bulletins for our various health benefit plans.
Mar. 1, 2021
March 2021 Network Bulletin overviewThe March Network Bulletin includes updates for medical and reimbursement policy updates, along with updates on prior authorization for Radiology, Cardiology, Radiation Therapy and facet Injections. There are also updates on home health, electronic payments, site of service review and more.
Mar. 1, 2021
New Jersey: New utilization review time framesEffective June 1, 2021, initial utilization reviews for radiology, cardiology and radiation therapy in New Jersey will be adjusted to 72 hours for commercial plans.
Mar. 1, 2021
New York: National Drug Code reportingStarting June 1, 2021, an accurate National Drug Code (NDC) must be reported for all physician-administered drugs billed on the Institutional Claim form.
Mar. 1, 2021
Oncology supportive care medication sourcing requirementStarting with dates of service on June 7, 2021, outpatient hospitals must obtain certain oncology supportive care medications from the participating specialty pharmacies we indicate, except as otherwise authorized by us.
Mar. 1, 2021
Radiology and cardiology prior authorization updatesEffective Jun. 1, 2021, we are updating the procedure code lists for the radiology and cardiology notification and prior authorization programs.
Mar. 1, 2021
Reimbursement Policy Update Bulletins: March 2021You can review the details on March’s reimbursement policy updates through the commercial, Medicare, Medicaid and Exchange plan bulletins.
Mar. 1, 2021
Specialty Medical Injectable Drug Program Updates: March 2021Monthly update for the Specialty Medical Injectable Drug Program Bulletin.
Mar. 1, 2021
2nd quarter prescription drug listCommercial plan Prescription Drug List and Pharmacy Benefit Coverage Updates that will take effect May 1, 2021 are now available to view.
Apr. 1, 2021
Medical Policy Update Bulletins: April 2021You can review the medical policy update bulletins for our various health benefit plans.
Apr. 1, 2021
April 2021 Network Bulletin overviewThe April Network Bulletin includes updates for medical and reimbursement policy updates. Along with genetic and molecular testing prior authorization, anti-emetics prior authorization, Outpatient Procedure Grouper annual update and more.
Apr. 1, 2021
Reimbursement Policy Update Bulletins: April 2021UnitedHealthcare April reimbursement policy updates for commercial, Medicare, Medicaid and Exchange plans.
Apr. 1, 2021
Specialty Medical Injectable Drug Program Updates: April 2021Monthly update for the Specialty Medical Injectable Drug Program Bulletin.
May 1, 2021
Medical Policy Update Bulletins: May 2021Medical policy updates for May 2021 for the following plans: Medicare, Medicaid, Exchanges, commercial and commercial affiliates.
May 1, 2021
May 2021 Network Bulletin overviewThe May Network Bulletin includes updates for medical and reimbursement policy updates. Along with genetic and molecular testing prior authorization, antiemetics prior authorization, outpatient procedure grouper annual update and more.
May 1, 2021
Reimbursement Policy Update Bulletins: May 2021You can review the details on May’s reimbursement policy updates through the commercial, Medicare, Medicaid and Exchange plan bulletins.
May 1, 2021
Specialty Medical Injectable Drug Program Updates: May 2021Specialty Drug Program Updates for UnitedHealthcare Commercial, Community Plan, Medicare Advantage, and Value & Balance Exchange plans for May 1, 2021.
June 1, 2021
EDI claim edits coming soonWe’re giving you advance notice of EDI claim edits that will be implemented in the coming months.
June 1, 2021
Louisiana: Submit a complete inpatient authorization requestSubmitting a complete concurrent inpatient authorization request for UnitedHealthcare Community Plan of Louisiana members will help reduce our follow-up calls and can help you avoid claim issues
June 1, 2021
Medical Policy Update Bulletins: June 2021Medical policy updates for June 2021 for the following plans: Medicare, Medicaid, Exchanges, and commercial.
June 1, 2021
New states in scope for naviHealth post-acute careBeginning Aug. 1, 2021, naviHealth will manage post-acute care for UnitedHealthcare Medicare Advantage members in Alabama, Maine, Massachusetts, New Hampshire, Rhode Island, Tennessee and Vermont.
June 1, 2021
June 2021 Network Bulletin overviewThe June Network Bulletin includes updates for medical and reimbursement policy updates. Along with genetic and molecular testing prior authorization, antiemetics prior authorization, outpatient procedure grouper annual update and more.
June 1, 2021
Medicaid: New prior authorization codes in select statesWe are adding new codes to the prior authorization list for UnitedHealthcare Community Plans (Medicaid, Long-Term Care) in Hawaii, Florida, Mississippi, New Jersey, Ohio, Pennsylvania and Tennessee.
June 1, 2021
Oncology specialty pharmacy requirement delaySourcing requirement for outpatient hospitals to obtain certain oncology supportive care medications for UnitedHealthcare commercial plan members will go into effect on June 18, 2021, not June 7, 2021 as previously announced in March and April 2021
June 1, 2021
Medicaid anti-emetic prior authorization updateEffective Aug. 1, 2021, prior authorization is required for 8 anti-emetics codes for cancer patients with UnitedHealthcare Community Plans in Arizona, Kentucky and Tennessee.
June 1, 2021
Reimbursement Policy Update Bulletins: June 2021You can review the details on June’s reimbursement policy updates through the commercial, Medicare, Medicaid and Exchange plan bulletins.
June 1, 2021
Specialty Medical Injectable Drug Program Updates: June 2021Specialty Medical Drug Program updates for UnitedHealthcare Commercial, Community Plan, Medicare Advantage, and Value & Balance Exchange plans for June 1, 2021.
July 1, 2021
Commercial plan prescription drug list updateThe September 1, 2021 Prescrption Drug List and pharmacy benefit updates for our commercial plans, are now available for review.
July 1, 2021
Exchange Plans: Prior authorization and site of service updatesStarting Oct. 1, 2021, UnitedHealthcare is updating prior authorization and site of service review requirements for UnitedHealthcare Individual Exchange plans.
July 1, 2021
Laboratory test registration requirement delayedIn response to the COVID-19 public health emergency, we are delaying implementation of the Laboratory Test Registry protocol until further notice.
July 1, 2021
Medicaid 3rd Quarter 2021 preferred drug listThe UnitedHealthcare Community Plan (Medicaid) preferred drug list (PDL) is updated quarterly by our Pharmacy and Therapeutics Committee. Changes will be effective July 1, 2021.
July 1, 2021
Radiation therapy authorization requirements for MedicaidThere are new prior authorization requirements for radiation therapy. Changes will start on Oct. 7, 2021, for UnitedHealthcare Community Plan members in certain states.
July 1, 2021
Medical Policy Update Bulletins: July 2021Medical policy updates for July 2021 for the following plans: Medicare, Medicaid, Exchanges, and commercial.
July 1, 2021
July 2021 Network Bulletin overviewThe overview of UnitedHealthcare’s policy and protocol changes is posted monthly to notify and help healthcare professionals submit prior authorization request, claims for reimbursement and more.
July 1, 2021
New York: Injectable cancer therapy updateEffective Oct. 1, 2021, Optum will begin managing our prior authorization requests for outpatient injectable cancer therapy.
July 1, 2021
2021–2022 Preferred Lab Network expansionSpecialty Medical Drug Program updates for UnitedHealthcare Commercial, Community Plan, Medicare Advantage, and Value & Balance Exchange plans for July 1, 2021.
July 1, 2021
Reimbursement Policy Update Bulletins: July 2021You can review the details on July’s reimbursement policy updates through the commercial, Medicare, Medicaid and Exchange plan bulletins.
July 1, 2021
Specialty Medical Injectable Drug Program Updates: July 2021Specialty Medical Drug Program updates for UnitedHealthcare Commercial, Community Plan, Medicare Advantage, and Value & Balance Exchange plans for July 1, 2021.
July 1, 2021
Specialty Pharmacy Drug List updateMedications added to the Specialty Pharmacy Requirements Drug List for commercial plans
Aug. 1, 2021
Electronic payments required for UnitedHealthcare Community Plan of ArizonaWe will no longer send paper checks for claim payments to Community Plan health care professionals in Arizona.
Aug. 1, 2021
Kentucky: Prior authorization and site of service updateStarting Oct. 1, 2021, UnitedHealthcare is expanding prior authorization requirements and site of services reviews for certain surgical, colonoscopy, office and MRI/CT procedures in Kentucky.
Aug. 1, 2021
Maryland: New outpatient injectable drug requirementsBeginning Nov. 1, 2021, prior authorization will be required for new outpatient injectable drugs for UnitedHealthcare Community Plan of Maryland members.
Aug. 1, 2021
New states in-scope for naviHealth post-acute careEffective Oct. 1, 2021, your post-acute care workflow will change for UnitedHealthcare® Medicare Advantage members in Arkansas, Delaware, Hawaii, Idaho, Louisiana, Mississippi, Montana, Nevada, Pennsylvania, Utah, West Virginia and Wyoming.
Aug. 1, 2021
Medicaid: New facet injection codes for prior authorization in select statesStarting Nov. 1, 2021, 6 prior authorization codes for facet injections (64490–64495) will be added to UnitedHealthcare Community (Medicaid) Plans in Arizona, California, Maryland, Mississippi, Missouri, New Jersey and Wisconsin.
Aug. 1, 2021
Medical Policy Updates August 2021Medical policy updates for August 2021 for the following plans: Medicare, Medicaid, Exchanges, and commercial.
Aug. 1, 2021
August 2021 Network Bulletin overviewThe policy and protocol updates for August 2021 include prior authorization changes for cardiovascular and commercial plan codes. You can also review the changes to medical PRAs, post-acute care management and more.
Aug. 1, 2021
New Jersey: Medicaid prior authorization requirements for certain therapy servicesEffective Oct. 1, 2021, we’ll require prior authorization for all OT, PT and ST services for UnitedHealthcare Community Plan of New Jersey members.
Aug. 1, 2021
New Jersey: Updated codes for early elective delivery prior authorizationHere is an updated code list for the early elective delivery (EED) prior authorization codes, effective Jan. 1, 2021, for UnitedHealthcare Community Plans in New Jersey.
Aug. 1, 2021
Radiation therapy prior authorization for Oxford Health PlanEffective Nov. 7, 2021, UnitedHealthcare will require prior authorization for Oxford Health Plan members for certain radiation therapy services.
Aug. 1, 2021
Prior authorization code updates for commercial plansWe’re adding codes to the prior authorization list for UnitedHealthcare commercial plans (to include All Savers, River Valley, Neighborhood Health Partnership, UnitedHealthcare West, MidAtlantic Health Plans).
Aug. 1, 2021
Reimbursement Policy Update Bulletins: August 2021You can review the details on August’s reimbursement policy updates through the commercial, Medicare, Medicaid and Exchange plan bulletins.
Aug. 1, 2021
Specialty Medical Injectable Drug Program Updates: August 2021Specialty Medical Drug Program updates for UnitedHealthcare Commercial, Community Plan, Medicare Advantage, and Value & Balance Exchange plans for August 2021.
Aug. 1, 2021
West Region: Medical provider remittance advice won’t be mailed after OctoberStarting Nov. 5, 2021, provider remittance advice (PRAs) for medical claims will no longer be mailed to in-network providers and facilities in the following states: Alaska, Arizona , California, Colorado , Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Washington and Wyoming.
Sept. 1, 2021
Medicare Advantage Service Area Reductions 2022Annual evaluations for Medicare Advantage plans may lead to service area reductions and plan terminations.
Sept. 1, 2021
Medical Policy Update Bulletins: September 2021Medical policy updates for September 2021 for the following plans: Medicare, Medicaid, Exchanges, and commercial.
Sept. 1, 2021
Mississippi: Electronic payments required for UnitedHealthcare Community PlanWe will no longer send paper checks for claim payments to Community Plan health care professionals in Mississippi.
Sept. 1, 2021
September 2021 Network Bulletin overviewThe policy and protocol updates for September 2021 include prior authorization changes for radiology, self-administered drug claims . You can also review the changes to medical PRAs, post-acute care management and more.
Sept. 1, 2021
Pennsylvania and New Jersey: Hysterectomy prior authorization criteria changeEffective Nov. 1, 2021, UnitedHealthcare Community Plans (Medicaid, Long-Term Care) in New Jersey and Pennsylvania will have a criteria change to hysterectomy prior authorization CPT code 58573.
Sept. 1, 2021
Southeast and Central: Medical PRAs won’t be mailed after NovemberStarting Dec. 10, 2021, UnitedHealthcare provider remittance advice (PRAs) for medical claims will no longer be mailed to in-network providers and facilities in the following states: ND, SD, NE, KS, OK, TX, MN, IA, MO, AR, LA, WI, IL, MI, IN, OH, KY, TN, NC, SC, MS, AL, GA, FL. View in the portal, through Optum Pay or EDI.
Sept. 1, 2021
Radiology prior authorization updatesRadiology prior authorization code updates for UnitedHealthcare Community Plan, commercial and Exchange
Sept. 1, 2021
Reimbursement Policy Update Bulletins: September 2021You can review the details on September’s reimbursement policy updates through the commercial, Medicare, Medicaid and Exchange plan bulletins.
Sept. 1, 2021
Specialty Medical Injectable Drug Program updates: September 2021Specialty Medical Drug Program updates for UnitedHealthcare Commercial, Community Plan, Medicare Advantage, and Value & Balance Exchange plans for September, 2021.
Sept. 1, 2021
States Added to Medical Review for Self-administered DrugsUnitedHealthcare® Commercial plans add eleven states to medical review process for self-administered drugs that should be billed through the member pharmacy benefit.
Sept. 1, 2021
Tufts Freedom Health Plan policy updateTufts Health Freedom Plan policy update for Massachusetts, Maine, New Hampshire, Vermont and Rhode Island.
Sept. 1, 2021
Texas: Maternal level-of-care reimbursementEffective Dec. 1, 2021, we will reimburse maternal services for Medicaid members to hospitals that align with the level-of-care designations assigned by the Texas Health and Human Services Commission (HHSC).
Oct. 1, 2021
Genetic and molecular testing updatesUnitedHealthcare will require prior authorization for additional genetic and molecular testing CPT® codes for commercial plan members.
Oct. 1, 2021
2022 UnitedHealthcare Individual Exchange plansOn Jan. 1, 2022, UnitedHealthcare will launch Individual and Family plans on the exchange in 7 new states. Learn about plan requirements, including prior authorization, referrals, site of service medical necessity reviews and more.
Oct. 1, 2021
Kentucky: Prior authorization and site of service updateFor dates of service on or after Jan. 1, 2022, for UnitedHealthcare commercial plans, we’re expanding our prior authorization requirements to include certain surgical, screening colonoscopy, office and MRI/CT imaging procedures in Kentucky.
Oct. 1, 2021
Medicare: Prior authorization required for oncology anti-emeticsStarting Jan. 3, 2022, prior authorization requirements expand for oncology anti-emetic drugs for some Medicare Advantage members.
Oct. 1, 2021
Medicare: New required Part B step therapy prior authorizationsUnitedHealthcare Medicare Advantage members will have new step therapy prior authorization requirements starting Jan. 1, 2022.
Oct. 1, 2021
Medicare: Changes to outpatient prior authorization process for non-oncology drugsStarting in January, the prior authorization request submission system is changing for Medicare Part B non-oncology medications.
Oct. 1, 2021
Medical Policy Update Bulletins: October 2021Medical policy updates for October 2021 for the following plans: Medicare, Medicaid, Exchanges, and commercial.
Oct. 1, 2021
October 2021 policy and protocol updates overviewThe policy and protocol updates for October 2021 include prior authorization changes for anti-emetics and genetric and molecular testing. You can also review the changes to speciality pharmacy requirements and updates for 2022.
Oct. 1, 2021
New Jersey: 2022 referral updateStarting Nov. 17, 2021, UnitedHealthcare Community Plan of New Jersey is implementing a referral process for members who need specialty care. This will require primary care providers (PCPs) to generate a referral for members to see in-network specialists.
Oct. 1, 2021
New York: Update to injectable cancer therapy effective dateEffective Feb. 1, 2022, Optum will begin managing our prior authorization requests for outpatient injectable cancer therapy.
Oct. 1, 2021
Policy and protocol updates in 2022Starting Jan. 1, 2022, you will be able to find your policy and protocol updates from UnitedHealthcare under the policy and protocol updates category on our news page – UHCprovider.com/news.
Oct. 1, 2021
Reimbursement Policy Update Bulletins: October 2021You can review the details on October’s reimbursement policy updates through the commercial, Medicare, Medicaid and Exchange plan bulletins.
Oct. 1, 2021
Specialty Medical Injectable Drug Program updates: October 2021Specialty Medical Drug Program updates for UnitedHealthcare Commercial, Community Plan, Medicare Advantage, and Value & Balance Exchange plans for October 2021.
Oct. 1, 2021
Specialty pharmacy drug list updateEffective for dates of service on Jan. 1, 2022, we’re adding new drugs to the specialty pharmacy drug list for commercial plans.
Oct. 1, 2021
Medicaid: Prior authorization changes coming in TexasEffective Nov. 1, 2021, you’re required to submit a prior authorization for certain drugs used to treat multiple sclerosis (MS) or high phosphate levels in Texas UnitedHealthcare Community Plan members.
Nov. 1, 2021
Appeal decision letters won’t be mailed in 2022Beginning Feb. 11, 2022, most contracted medical providers will need to view Medicare Advantage (including Dual Special Needs) and commercial appeal decision letters online in Document Library or with API.
Nov. 1, 2021
Arizona: Changes to facet injection codes for prior authorizationStarting Feb. 1, 2022, 6 prior authorization codes for facet injections (64490–64495) will be added to the UnitedHealthcare commercial plan in Arizona.
Nov. 1, 2021
Cardiac event monitoring prior authorization changePrior authorization will be required for dates of service beginning Feb. 1, 2022, for certain cardiology CPT codes and associated HCPCS for Medicare Advantage members.
Nov. 1, 2021
Commercial plan 2022 prescription drug list updateThe Jan. 1, 2021, prescription drug list and pharmacy benefit updates for UnitedHealthcare commercial plans are now available for review on UHCprovider.com.
Nov. 1, 2021
Correction: Pain management and injection prior authorizationCPT® codes 62292, 64454, 64480, 64491, 64492, 64494, 64496, 64634 and 64636, listed under pain management and injections, will not be subject to prior authorization requirements on Nov. 1, 2021, for UnitedHealthcare commercial plans including All Savers, River Valley, Neighborhood Health Partnership, UnitedHealthcare West and MidAtlantic Health Plans.
Nov. 1, 2021
Changes to electrophysiology implant prior authorizationStarting Dec. 1, 2021, we’ll not require prior authorization and notification for electrophysiology implant procedures subject to the UnitedHealthcare outpatient cardiology notification/prior authorization protocol when performed and appropriately billed as an inpatient service for UnitedHealthcare Community Plan, Medicare, commercial and Exchange plan members.
Nov. 1, 2021
New health plan for Massachusetts dual-eligible membersUnitedHealthcare Connected® for One Care will be available to individuals in Massachusetts eligible for both Medicare and Medicaid.
Nov. 1, 2021
New Medicare Advantage plans for 2022In 2022, our Medicare Advantage and special needs plans will be available to more eligible individuals.
Nov. 1, 2021
2022 changes to the Medicare Advantage hospice benefitStarting Jan. 1, 2022, the CMS VBID hospice benefit component will change UnitedHealthcare Medicare Advantage member benefits for hospice services in Alabama, Illinois, Oklahoma and Texas.
Nov. 1, 2021
Medicare and DSNP: Prior authorization and site of service expansionStarting May 1, 2022, for UnitedHealthcare Medicare Advantage plans, we’re expanding our prior authorization requirements and site of service medical necessity reviews for certain surgical procedures.
Nov. 1, 2021
Medicare new prior authorization requirement that includes clinical submissionUnitedHealthcare Medicare plan prior authorization changes for PT, OT and ST services at multi-disciplinary offices and outpatient hospital settings for Arkansas, Georgia, New Jersey and South Carolina.
Nov. 1, 2021
Medical Policy Update Bulletins: November 2021Medical policy updates for November 2021 for the following plans: Medicare, Medicaid, Exchanges, and commercial.
Nov. 1, 2021
Northeast: Medical PRAs going paperless in FebruaryStarting Feb. 4, 2022, UnitedHealthcare will no longer mail provider remittance advice (PRAs) for medical claims to network providers and facilities in the following states: CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VA, VT and WV. View in the portal through Optum Pay or EDI.
Nov. 1, 2021
Nebraska: Heritage Health Adult benefit expansionHeritage Health Adult (HHA) has expanded Medicaid coverage to patients, ages 19–64, whose income is at or below 138% of the federal poverty level. All HHA members are now eligible for benefits under a single package.
Nov. 1, 2021
November 2021 policy and protocol overviewThe policy and protocol updates for November 2021 include prior authorization changes for site of service reviews, clinical submission requirements, private duty nursing and cardiac event monitoring. You can also review the changes to appeal decision letters and paperless PRAs along with updated pharmacy and prescription drugs lists.
Nov. 1, 2021
Prior authorization and site of service updatesStarting Feb. 1, 2022, we’re updating the prior authorization requirements and site of service medical necessity reviews for certain surgical procedures. These updates apply to UnitedHealthcare commercial and Individual Exchange plans.
Nov. 1, 2021
Prior authorization changes for private duty nursingStarting Feb. 1, 2022, we’ll require prior authorization for HCPCS code T1000. This code covers private duty nursing, which is a complimentary benefit offered to designated Medicare Advantage retiree plans through UnitedHealthcare Retiree Solutions.
Nov. 1, 2021
Reimbursement Policy Update Bulletins: November 2021You can review the details on November’s reimbursement policy updates through the commercial, Medicare, Medicaid and Exchange plan bulletins.
Nov. 1, 2021
Specialty Medical Injectable Drug Program updates: November 2021Specialty Medical Drug Program updates for UnitedHealthcare Commercial, Community Plan, Medicare Advantage, and Individual Exchange plans for November 2021.
Nov. 1, 2021
Specialty pharmacy drug list updateEffective for dates of service beginning on Dec. 1, 2021, Nulibry™ is added to the specialty pharmacy drug list for commercial plans.
Nov. 1, 2021
UnitedHealthcare — committed to price transparency and disclosureUnitedHealthcare follows all CAA, government-mandated price transparency and disclosure regulations regarding our agreements with health care professionals, medical groups, facilities and ancillary providers.
Dec. 1, 2021
District of Columbia: Electronic payments required for UnitedHealthcare Community PlanUnitedHealthcare has made changes to its claim payment platform that will eliminate the use of paper checks for claim payments to Community Plan health care professionals in the District of Columbia.
Dec. 1, 2021
Exchange plans: Prior authorization not required for outpatient therapy servicesStarting Dec. 1, 2021, UnitedHealthcare Individual Exchange plans will not require prior authorization for outpatient therapy services (physical, occupational and speech therapy), up to the member’s benefit limit.
Dec. 1, 2021
New prior authorization requirements for Individual Exchange plansStarting March 1, 2022, several new clinical categories will require prior authorization for Individual Exchange plans.
Dec. 1, 2021
Massachusetts: Prior authorization and site of service updateWe previously announced a Jan. 1, 2022, implementation date for prior authorization and site of service reviews for certain procedures, for commercial plans in Massachusetts. We’re delaying this implementation until further notice.
Dec. 1, 2021
Medical Policy Update Bulletins: December 2021Medical policy updates for December 2021 for the following plans: Medicare, Medicaid, Exchanges, and commercial.
Dec. 1, 2021
December 2021 policy and protocol updates overviewPrior authorization updates and requirements for radiology, exchange plans and outpatient therapy services. Review the latest UnitedHealthcare medical policy and pharmacy updates.
Dec. 1, 2021
Radiology prior authorization update delayEffective March 1, 2022, the updated procedure codes for the radiology prior authorization program for UnitedHealthcare commercial and Exchange plans will go into effect.
Dec. 1, 2021
Reimbursement Policy Update Bulletins: December 2021You can review the details on December’s reimbursement policy updates through the commercial, Medicare, Medicaid and Exchange plan bulletins.
Dec. 1, 2021
Specialty Medical Injectable Drug program updates: December 2021Specialty Medical Drug Program updates for UnitedHealthcare Commercial, Community Plan, Medicare Advantage, and Value & Balance Exchange plans for December 2021.
Dec. 1, 2021
Texas: Medicaid prior authorization changes for 2022Effective Nov. 1, 2021, you’re required to submit a prior authorization for certain drugs used to treat multiple sclerosis (MS) or high phosphate levels in Texas UnitedHealthcare Community Plan members.
Sept. 3, 2021
Support for health care professionals and members affected by severe weather and other emergenciesOur priority is making sure people have immediate and easy access to the care they need and that we’re supporting you and your practice. UnitedHealthcare is taking action to help those who may be affected by wildfires, hurricanes, storms and other severe weather.
Oct. 21, 2021
2020 Quality Improvement Program overviewUnitedHealthcare maintains a Quality Improvement (QI) program to improve our members’ and providers’ health care experience. The following are the most important activities in our QI 2020 program for UnitedHealthcare commercial plans.
May 3, 2021
2021 National Nurses WeekThis past year, you’ve sacrificed your time, energy and health. You’ve worked late nights and long shifts. You’ve held the hands of the sick and offered words of encouragement to worried family members. We’re grateful for all you do. Thank you for showing what care can do each and every day to improve health in our communities.
July 29, 2021
Use required 340B modifiers for accurate paymentCMS and UnitedHealthcare require a JG modifier on Medicare claims for separately payable, OPPS 340B drugs and biologics (status indicator K) to receive claims payment of ASP minus 22.5%.
Oct. 19, 2021
Take 5 minutes to update your telehealth detailsTake a 5-minute survey to help ensure we have your most recent information to display in our provider directories
Oct. 22, 2021
Arizona: New clinical assessment requirements coming soonStarting July 1, 2021, UnitedHealthcare Community Plan of Arizona network providers will be required to use the CALOCUS and LOCUS instruments to help identify children with complex needs.
Oct. 22, 2021
Arizona: Update your AHCCCS registrationReferring, ordering, prescribing and attending providers: Update registration with the Arizona Healthcare Cost Containment System (AHCCCS).
Apr. 27, 2021
Want to share your point of view?Arizona Health Care Cost Containment System is conducting a survey to determine performance and responsiveness to health care professionals contracted with UnitedHealthcare Community Plan.
Aug. 17, 2021
Time’s almost up: Link’s going away for goodIn October 2021, all self-service tools will officially retire from Link and transition to the new UnitedHealthcare Provider Portal.
Nov. 2, 2021
API: Improve efficiency and reduce cost with real-time data exchangeApplication Programming Interfaces allow electronic health care data exchange between practice management systems, including interoperability.
January 13, 2021
Avoid Claim Errors for Annual Wellness VisitsAvoid claim errors for annual wellness visits by using the correct diagnoses and codes.
Mar. 15, 2021
Avoid claim denials: Tips for Exchange plansAvoid claim errors by ensuring you’re following Exchange plan referral requirements
Oct. 22, 2021
Arizona Medicaid: Update to fraud and abuse requirementsThe Arizona Health Care Cost Containment System (AHCCCS) has updated its fraud and abuse requirements for health care professionals and subcontractors, effective Oct. 1, 2021.
Aug. 12, 2021
Arizona: Avoid denials with timely filing of claimsTimely filing of claims helps ensure claims payment to health care professionals who participate with UnitedHealthcare Community Plan in Arizona
Oct. 22, 2021
Arizona: Update COVID-19 vaccination records through ASIISFor most vaccinations, including COVID-19, you’re required to use ASIIS.
Aug. 12, 2021
Arizona: Two accredited health equity education CME resources available on demandOptumHealth Education and UnitedHealthcare are here to support you with 2 free, CME/CE-accredited education activities, designed to help you navigate the complexities of health equity.
Oct. 22, 2021
Arizona: Free translation services for your patientsUnitedHealthcare Community Plan of Arizona offers free translation and interpretation services to help ensure members understand their diagnosis and treatment plan in a culturally sensitive manner. More than 240 non-English languages and hearing-impaired services are available.
July 7, 2021
Arizona: Suspect Medicaid fraud? Learn how to report itOur Medicaid fraud, waste and abuse program focuses on detection and investigation of fraud. Learn about reporting requirements for UnitedHealthcare Community Plan of Arizona network care providers.
Oct. 22, 2021
Arizona: Help for your patients with chronic painUnitedHealthcare Community Plan of Arizona has identified Pima Pain Center as a Center of Excellence in the treatment of complex pain conditions. Pima Pain Center provides integrated care for patients who struggle with chronic pain, including those who have an opioid use disorder.
July 28, 2021
Arizona: Avoid claim denials for social determinants of healthThe Arizona Healthcare Cost Containment System (AHCCCS) has specific guidelines for listing social determinants of health (SDOH) codes on claims for Medicaid members. Care providers should follow these guidelines to avoid claim denials.
Nov. 1, 2021
Arizona: Support for young adults with special needsUnitedHealthcare Community Plan of Arizona is looking for primary care providers (PCPs) who provide care — or are willing to provide care — for young adults with autism spectrum disorder (ASD) and/or complex/special health care needs as they transition to adult care providers.
Nov. 12, 2021
Coordinating care with behavioral health care professionalsCoordinating care can help ensure care for all patients, especially for those with complex conditions.
Nov. 2, 2021
UHCprovider.com behavioral health resourcesOnline resources to help PCPs screen patients for behavioral health conditions.
Oct. 22, 2021
Prepare for patients with Bind health insuranceAdd Bind to registration and claim system today.
Nov. 11, 2021
Webinar breaks down Bind personalized health planBind is offering a webinar to help health care professionals learn more about Bind and how to quickly and efficiently file claims and get the educational resources they need.
Sept. 10, 2021
Ready for a busy Fall vaccination season?Get vaccination news, education and resources to stay updated during a busy Fall vaccination season.
January 14, 2021
Enroll in the CA COVID-19 vaccination programEnrollment in the state’s program is required before you can administer COVID-19 vaccines.
Oct. 25, 2021
California: Medi-Cal changes help simplify and add flexibilityStarting Jan. 1, 2022, California Advancing and Innovating Medi-Cal (CalAIM) will help move Medi-Cal to a more consistent and seamless system. Enhanced care management (ECM) will provide community-based case management for UnitedHealthcare Community Plan of California members previously served in whole-person care (WPC) pilots and health homes programs (HHP). Members may receive community supports.
May 12, 2021
What's new with Cancer Therapy Pathways ProgramStarting May 1, 2021, the Cancer Therapy Pathways program will include follicular lymphoma and marginal zone lymphoma.
Apr. 15, 2021
Help your patients use Care CashNov. 15, 2021
Change in post-acute care managementEffective April 1, 2021, naviHealth will manage post-acute care for Medicare Advantage members in additional markets.
Oct. 27, 2021
New clinical pharmacist-led medication optimization programUnitedHealthcare is excited to introduce our Comprehensive Medication Management (CMM) program, a patient-centered, interactive review of current medications that may include prescription and non-prescription medications, as well as herbal supplements.
June 4, 2021
Colorado: Direct lines make prior authorizations faster, easierNew dedicated prior authorization call center numbers for Optum’s Colorado AARP HMO members. Optum Card ID updates to be completed by year-end.
January 14, 2021
Colorado: Administrative changes for MedicareYou’ll follow a new process for submitting claims, prior authorization requests and more for some UnitedHealthcare Medicare Advantage HMO members.
Sept. 8, 2021
Colorado: New Provider for Medicare Advantage HMOBeginning Oct. 1, 2021 Preferred Homecare is the new capitated provider for the Medicare Advantage HMO members in Colorado.
Oct. 19, 2021
New preventative care support for your patientsImmunochemical fecal occult blood tests (iFOB or FIT) will be sent to UnitedHealthcare commercial plan members within a month of turning age 50.
July 13, 2021
Refer your patients to a Designated Diagnostic Provider (DDP) for lab servicesThrough Designated Diagnostic Provider, we can help manage costs and drive transparency by connecting patients to lab services that meet certain quality and cost-efficiency criteria.
Oct. 21, 2021
Correction: October 2021 Reimbursement Policy Update BulletinCorrection to the October 2021 Reimbursement Policy Update Bulletin for the policy for Services by Unlicensed Residents and Medical Students, Professional. The Jan. 1, 2021, effective date does NOT apply to Arizona, Kansas, Mississippi, Nebraska, New Jersey, Tennessee or Texas.
July 15, 2021
Find COVID-19 vaccine availability for your state or territoryYour state’s health department has information about local COVID-19 vaccine availability.
Nov. 2, 2021
Building COVID-19 vaccine confidenceWe’ve provided COVID-19 vaccine resources to review and share with your patients who may be hesitant about receiving the vaccination.
Oct. 19, 2021
Adding providers to an existing contracted groupCredentialing requirements, non-delegated providers, submitting request for participation form
Sept. 13, 2021
Dialysis claims billing updateUnitedHealthcare® Medicare Advantage will require dialysis providers to submit claims with the following modifiers. We notified you in August 2021 that effective Oct. 1, 2021, you need to use CG or KX for dialysis treatment revenue codes 821 and 881 when billing with CPT® code 90999.
Aug. 30, 2021
Dialysis claims billing updateEffective Oct. 1, 2021, in accordance with Centers for Medicare & Medicaid (CMS) guidelines, UnitedHealthcare® Medicare Advantage® will require dialysis providers to submit claims with the following modifiers.
Sept. 7, 2021
See for yourself how UnitedHealthcare solutions can help your practiceThe UnitedHealthcare Digital Practice provides an on-demand resource that shows opportunities where we can help create efficiencies, which may give you more time with your patients and the members we serve.
Oct. 19, 2021
Direct deposits now managed through Optum Pay for UnitedHealthcare West PlansAs of Feb. 2, 2021, UnitedHealthcare West health care professionals can now update and manage direct deposit (ACH) and payment information through Optum Pay.
Apr. 16, 2021
EDI claim edits coming soonWe’re giving you advance notice of EDI claim edits that will be implemented in the coming months.
Sept. 13, 2021
New EDI edits for Medicare Advantage claimsAs of Aug. 28, 2021, the new payer-level edits for Electronic Data Interchange (EDI) 837 claim submissions provide alerts of specific information that may be missing or doesn’t match data contained in our systems.
Sept. 8, 2021
Get real-time patient information in your EMRPoint of Care Assist® is a virtual assistant that puts personalized, real-time patient data, including labs, prior authorization, eligibility and cost information, directly in your hands within the EMR.
Sept. 13, 2021
Enroll to get enhanced payments as an LTSS providerEnroll in our ACEP program to get rate enhancement payments as a Long-Term Services and Supports (LTSS) care provider for UnitedHealthcare Community Plan members in Texas.
Sept. 15, 2021
New Florida Medicare Advantage plans in 2022Starting Jan.1, 2022, UnitedHealthcare is launching a new AARP® Medicare Advantage (HMO) plan and expanding existing Medicare Advantage plans into more Florida counties.
Sept. 3, 2021
Florida: In-home palliative care for UnitedHealthcare Medicare Advantage membersPalliative care services and support at home are available for UnitedHealthcare Medicare Advantage members in Florida with a chronic or long-term illness.
Feb. 17, 2021
Florida SBIRT tools for substance abuse issuesYou can play a role in identifying substance abuse risks by screening and helping patients make healthy decisions by referring them for treatment.
Oct. 22, 2021
Georgia, Virginia: Get to know Bind health insuranceThe Bind personalized health plan — backed by UnitedHealthcare — has received approval to offer fully insured benefit plans in Georgia and Virginia
July 28, 2021
Prior authorization for preimplantation genetic testing and fertility preservationEffective July 1, 2021, preimplantation genetic testing (PGT) and fertility preservation for iatrogenic infertility are covered as standard benefits for eligible UnitedHealthcare commercial plan members.
July 2, 2021
Genetic testing for hereditary cancer: Unproven codes for RNA testingEffective Dec. 1, 2020, 11 codes for RNA testing have been removed from the prior authorization requirement.
Nov. 10, 2021
Genetic prior authorization waiver expiringThe penalty waiver for genetic testing prior authorizations for commercial and E & I plans expires on Dec. 31, 2021.
June 30, 2021
Genetics Prior Authorization Program update for commercial and Community plan membersUnitedHealthcare commercial plan and Community Plan is waiving administrative penalties failing to comply with the prior authorization or notification requirement for any genetic test with service date in June.
Sept. 10, 2021
Goodbye Link, hello portalBy end of year, all self-service tools will officially retire from Link and transition to the new UnitedHealthcare Provider Portal.
Dec. 1, 2021
Hawaii: Registration requirement for Medicaid providersThe Hawaii Department of Human Services (DHS)/Med-QUEST Division (MQD) requires all care providers who serve QUEST members to register with the new MQD provider enrollment system, HOKU.
Sept. 15, 2021
Exchange plans: Referrals no longer needed for chiropractic careEffective Sept. 1, 2021, UnitedHealthcare Individual and Family Exchange plan members in Arizona, Maryland, North Carolina, Oklahoma, Tennessee and Washington State no longer need a referral to see a chiropractor.
June 29, 2021
Help your patients save moneyHelp Exchange patients avoid unnecessary cost efficiency and get the best value for their health care dollars. Refer them to a UnitedHealthcare Designated Diagnostic Provider for outpatient lab services.
June 16, 2021
Improve LGBTQ+ care with upcoming trainingA free and accredited live webinar on June 29 provides insight and training on improving care for the LGBTQ+ community. PRIDE 365+ offers more advanced training.
June 30, 2021
Indiana: 90-day continuity of care policyOn April 1, 2021, we instituted a 90-day continuity of care policy for UnitedHealthcare Community Plan members in Indiana coming from another MCE or Traditional Medicaid, or newly enrolled members.
June 30, 2021
Indiana: Genetic and molecular prior authorization processes changesThe Prior Authorization & Notification tool in Link will be temporarily unavailable for online requests for genetic and molecular testing starting June 1, 2021 for Indiana Hoosier Care Connect members.
Aug. 12, 2021
Take the guesswork out of reporting with UnitedHealthcare InsightsUnitedHealthcare Insights empowers your practice with the analytics and metrics to make more informed decisions.
Apr. 30, 2021
Reminder: We’re transitioning to InterQual®, effective May 1Helping you understand how our transition of InterQual clinical criteria may help you.
July 19, 2021
Introducing UnitedHealthcare InsightsUnitedHealthcare Insights empowers your practice with the analytics and metrics to make more informed decisions.
Oct. 22, 2021
Tennessee: Inappropriate Primary/Principle Diagnosis Policy, Facility UpdateIt was previously communicated Oct. 1, 2020, on the Community Plan Portal, that the UnitedHealthcare Community Plan is implementing a new Inappropriate Primary Diagnosis Policy, Facility, for facility claims. Implementation of this new facility policy has been delayed until on or after date of process June 1, 2021.
January 15, 2021
Kentucky Provider Orientation WebinarAs you and your staff begin providing care to new UnitedHealthcare Community Plan of Kentucky members in the Medicaid program, we want to make sure you have the information you need to do business with us. This new Medicaid program is for members currently enrolled in the state’s Medicaid, Children’s Health Insurance Program (CHIP), Aged, Blind or Disabled children and adults who are not eligible for Medicare. The program is available statewide as of Jan. 1, 2021.
June 16, 2021
Kentucky: Register to provide the COVID-19 vaccineYou can register with the Kentucky Department of Public Health to administer the COVID-19 vaccine through your practice.
June 15, 2021
Kentucky Provider Orientation WebinarAs you and your staff begin providing care to new UnitedHealthcare Community Plan of Kentucky members in the Medicaid program, we want to make sure you have the information you need to do business with us. This new Medicaid program is for members currently enrolled in the state’s Medicaid, Children’s Health Insurance Program (CHIP), Aged, Blind or Disabled children and adults who are not eligible for Medicare. The program is available statewide as of Jan. 1, 2021.
Aug. 12, 2021
Louisiana: Help Medicaid patients get cancer screeningsIf UnitedHealthcare Community Plan members have missed or delayed their preventive care, we have resources to help you recommend cancer screenings.
Feb. 16, 2021
LifeBridge Nebraska Physician Coaching ProgramPeer-to-peer wellness program intended to help physicians address challenges that come with their medical career.
Sept. 15, 2021
Managing information in the portal just got simplerWe simplified our security and registration process so you can easily register, add, change or deactivate users’ access to the portal.
May 24, 2021
Massachusetts: Area of Expertise (AOE) updates requiredEach Massachusetts Community and State (C&S) Medicaid provider must update their Area of Expertise (AOE) by Aug. 30 for the September provider directory. Update using My Practice Profile (MPP), email or phone.
Apr. 15, 2021
Questions for us? Talk to a Provider AdvocateWe invite you to attend a UnitedHealthcare WebEx informational session to learn more about our commercial and Medicare Advantage plans and policies in Colorado, Utah, Wyoming, Idaho and Montana. Ask us about HCA Healthcare, Intermountain Healthcare, OptumCare, Medicare expansion, Navigate expansion, Select Colorado and Doctors Plan.
June 30, 2021
Maryland: Asthma medication support for your practiceMaryland UnitedHealthcare Community Plan members with asthma may receive additional support for their medications. Health care professionals can receive a unique list for scheduling follow-up appointments.
May 13, 2021
Annual Maryland CAHPS results releasedRead the CAHPS (Consumer Assessment of Health Providers and Systems) adult and child survey results.
May 13, 2021
Maryland: Help your Medicaid patients prevent diabetesIf you have Maryland Medicaid patients with prediabetes or at risk for type 2 diabetes, the HealthChoice Diabetes Prevention Program (DPP) can help.
Aug. 12, 2021
Maryland: Get payment for diabetic eye examsMaryland: HCD International (HCDI) will support you in order to deliver high-quality care to your patients, help reduce cost, contribute to better clinical outcomes and encourage patient satisfaction.
June 14, 2021
Support for language services in MarylandUnitedHealthcare Community Plan’s diverse members receive cultural and language support.
June 14, 2021
Maryland program for patients with complex needsMaryland offers eligible Medicaid patients an alternative case management program for specified rare and expensive conditions.
Sept. 7, 2021
In-home palliative care for Medicare Advantage membersPalliative care services and support at home are available for UnitedHealthcare® Medicare Advantage members in Arizona, California, Colorado, Florida, Kansas, Kentucky, Maryland, Michigan, Nebraska, New Jersey, New York, Ohio, Rhode Island, Texas, Virginia, Washington and Wisconsin.
July 9, 2021
Medicaid: Take 5 minutes to share your point of viewUnitedHealthcare Community Plan network providers will have the opportunity to share their feedback about their experience working with us by taking our Physician Satisfaction Survey. This survey applies to physicians who participate in Medicaid.
Oct. 22, 2021
Medication adherence may improve with real-time EMR-integrated solutionPreCheck MyScript® is integrated into your electronic medical record (EMR) and shows patient-specific, real-time medication costs and coverage. This valuable information is provided right at the time of prescribing, directly within your workflow in the EMR system.
June 30, 2021
Michigan: Improve the way you work with usThe UnitedHealthcare Community Plan of Michigan webpage gives you direct access to resources and information to help you work with Medicaid patients.
Aug. 12, 2021
Michigan: Resources for your sickle cell care planTo help you treat patients with sickle cell disease, UnitedHealthcare Community Plan of Michigan has training, care managers and support resources.
Sept. 7, 2021
Required special needs plan Model of Care trainingThe Centers for Medicare & Medicaid Services (CMS) requires all special needs plans (S