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.
Effective 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.
If 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.
In 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).
UnitedHealthcare 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.
The 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.
Starting 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.
The 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.
The 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.
Sourcing 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
Effective 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.
Starting 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.
The 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.
We’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).
The 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.
Effective 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).
On 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.
For 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.
The 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.
Starting 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.
Effective 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.
CPT® 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.
Starting 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.
UnitedHealthcare 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.
Heritage 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.
The 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.
Starting 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.
Starting 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.
UnitedHealthcare follows all CAA, government-mandated price transparency and disclosure regulations regarding our agreements with health care professionals, medical groups, facilities and ancillary providers.
Starting 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.
We 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.
Effective 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.
Starting July 1, 2022, for UnitedHealthcare® Medicare Advantage and Dual
Special Needs Plans (D-SNP) in Alabama, there will be a change in the process
for requesting prior authorization for all visits after the start of care visit (SOC).
The Arizona Health Care Cost Containment System (AHCCCS) requires UnitedHealthcare to conduct quarterly phone surveys to help ensure the care providers in our network are complying with state appointment availability guidelines. We submit survey results to AHCCCS and the Division of Developmental Disabilities (DDD).
Arizona Health Care Cost Containment System (AHCCCS) has developed a set of
clinical toolkits to assist PCPs in assessing the needs of children/adolescents (8-
17 years old), and adults (18 years and older).
Starting May 20, 2022, UnitedHealthcare will no longer mail prior authorization and clinical letters to network providers and facilities in AL, AR, CT, DC, DE, FL, GA, IA, IL, IN, KS, KY, LA, MA, MD, ME, MI, MO, MS, NC, ND, NE, NH, NJ, NY, OH, OK, PA, RI, SC, SD, TN, TX, VA, VT, WI and WV.
California DHCS Policy Letter APL 21-014 and United States Preventive Services
Task Force (USPSTF) guidelines require primary care providers to provide alcohol
and drug Screening Assessment, Brief Interventions and Referral to Treatment
Beginning Jan. 1, 2022, the following changes will be effective in Colorado, Florida, Hawaii, Indiana, Maryland, Minnesota, Nevada, New Jersey, New York CHIP, New York EPP, New York Medicaid, Pennsylvania CHIP, Rhode Island and Virginia.
Information about becoming a Designated Diagnostic Provider for Imaging. this includes the steps to becoming a Designated Diagnostic Provider as well as links to a quality questionnaire that must be completed as part of the process.
Effective June 1, 2022, in accordance with your contractual agreement that you do business with us electronically, UnitedHealthcare is no longer sending paper checks for claim payments. This change supports our continued efforts to accelerate payments to your practice by moving to digital transactions.
Starting April 1, 2022, radiation therapy and chemotherapy services will require prior authorization for Individual Exchange plans in Arizona, Alabama, Florida, Georgia, Illinois, Louisiana, Maryland, Michigan, North Carolina, Oklahoma, Tennessee, Texas, Virginia and Washington.
Effective Jan. 1, 2022, Government Employees Health Association (GEHA) members in certain states will access the Choice Plus provider network if enrolled in the standard option, high option or high deductible health (HDHP) plans.
In collaboration with the State of Hawaii Med-QUEST Division (MQD) and the
Centene Institute for Advanced Health Education®, all Med-QUEST Health Plans
are pleased to offer providers with a new CME-eligible training: Vaccine Hesitancy:
How to Identify and Approach the “Movable Middle.”
Starting June 1, 2022, for UnitedHealthcare Medicare Advantage and Dual Special Needs Plans, we will require initial authorization and will perform continuation of care reviews for Home Health Agencies (HHAs). This change is taking place for members enrolled in Medicare Advantage plans, including Dual Special Needs plan members, who reside and receive services in Arkansas, South Carolina, and Texas.
Starting Feb. 2, 2022, we will no longer support the use of Internet Explorer 11 on UHCprovider.com and the UnitedHealthcare Provider Portal. For the best user experience, providers should change their browsers before then.
Medicaid benefits are suspended for UnitedHealthcare Community Plan members when they’re incarcerated. Benefits are reinstated when they’re released. However, sometimes you’ll find release dates need to be updated. We’ll work with the Department for Medicaid Services (DMS) to get eligibility updated in the KYMMIS.
For UnitedHealthcare Community Plan members who’ve been hospitalized for a mental illness, scheduling timely post-discharge appointments is vital to the member’s success after they’ve been discharged. The Follow-Up After Hospitalization for Mental Illness (FUH) HEDIS® measure assesses the percentage of inpatient discharges for a diagnosis of mental illness among patients ages 6 and older that resulted in follow-up care with a mental health provider within 7 days.
Effective Feb. 1, 2022, breast milk storage bags are covered as durable medical equipment for lactating UnitedHealthcare Community Plan members. Coverage is retroactive. You don’t need to take any action. We’ll reprocess impacted claims when our system is updated.
Effective June 16, 2022, universal drug testing/screening in a primary care setting will no longer be covered. Drug testing without signs or symptoms of substance use, or without current controlled substance treatment, will not be covered. Please be aware of this policy change when treating UnitedHealthcare Community Plan members and filing claims.
UnitedHealthcare Community Plan of Maryland works with health care professionals to complete medical record reviews required by the Maryland Department of Health (MDH). If you’re selected for an audit, we’ll look at your 2021 medical records to help make sure you’re meeting MDH Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements.
The Centers for Medicare & Medicaid (CMS) requires all Medicare members, including Dual Eligible Special Needs Plan (D-SNP) members, to know costs prior to receiving non-covered services. Request a prior authorization if you know or have reason to believe that a service for a Medicare Advantage member may not be covered.
A new FAQ is posted to provide additional information about UnitedHealthcare® Medicare plan submission requirements. These requirements affect physical therapy (PT), occupational therapy (OT) and speech therapy (ST) services in Arizona, Georgia, New Jersey and South Carolina.
Effective Feb. 4, provider remittance advice (PRAs) for medical claims to network health care professionals and facilities (primary and ancillary) in the Southeast, Central and Northeast regions will go paperless. This is a change from previous dates.
The Michigan Department of Health and Human Services (MDHHS) launched the We Treat Hep C Initiative to help eliminate the hepatitis C virus (HCV) in Michigan. The We Treat Hep C initiative has removed barriers to care and offers support to health care professionals testing and treating UnitedHealthcare Community Plan members for hepatitis C.
Effective May 1, 2022, UnitedHealthcare will expand the existing prior
authorization requirement for injectable chemotherapy drugs received in an
outpatient setting to include the UnitedHealthcare Community Plan of Minnesota.
Effective June 1, 2022, prior authorization will be required for cognitive rehabilitation services (procedure code H2012 HK) for UnitedHealthcare Community Plan members enrolled in Families & Children and MNCare plans. This requirement applies to members whose ID cards list the group number MNHCP.
Health homes are community-based organizations contracted with either MO HealthNet or Missouri Department of Mental Health to provide physical or behavioral health care management services to Medicaid members who meet the Centers for Medicare and Medicaid Services (CMS) criteria. Training is available today.
Effective Jan. 28, 2022, you’re required to electronically attach sterilization consent forms and child medical evaluation forms when submitting claims. There are special steps you need to take. Here’s how to do it.
Effective Aug. 1, 2022, you’ll see new codes on the prior authorization list for cardiovascular, prostate, and spinal surgery procedures. These changes impact UnitedHealthcare Community Plan of New Jersey’s Medicaid and Long-Term Care plans.
Commercial health care professionals contracted with the Empire Plan in New York can now use CAQH to verify, update and attest to their demographic data. They can also attest using MPP, mail or fax. This is now required every 90 days.
You were notified in January 2021 that effective July 1, 2021, Voluntary Foster Care Agencies (VFCAs) would no longer be the payor for services of children or youth in foster care. These patients were transitioned to a New York Medicaid managed care plan.
As referenced in the New York State Medicaid Update - September 2021 Volume
37 - Number 11, New York State (NYS) Medicaid does not cover prescription or
physician-administered drugs used for the treatment of sexual dysfunction (SD) or
erectile dysfunction (ED).
Starting Jan. 1, 2022, the current OrthoNet Oxford Call Center toll-free number, 888-381-3152, will be deactivated. Oxford providers should instead call the standard Oxford Provider Call Center at 800-666-1353.
The Pennsylvania Department of Human Services has updated its billing requirements for personal care services that are verified using an electronic visit verification (EVV) system. For dates of service starting May 1, 2022, health care professionals administering personal care services to UnitedHealthcare Community Plan members in their home must use HCPCS code T1019 when submitting claims and requesting prior authorization.
Two new features, have been added to the Prior Authorization tool in the UnitedHealthcare Provider Portal. Now submit a prior authorization cancellation request in the UnitedHealthcare Provider Portal with Cancel Case. Requests are also automatically saved with Save as Draft.
Effective June 1, 2022, procedure codes will be updated for the radiology
notification and prior authorization and cardiology prior authorization programs for
UnitedHealthcare Community Plan, Commercial and Exchange.
In compliance with the Health and Human Services (HHS) - Risk Adjustment Data Validation (RADV) program, we are required to provide supporting medical documentation to enable the audit of medical encounter(s) for UnitedHealthcare members.
Starting January 2022, primary care providers in Texas, Virginia and Wisconsin, currently connected to the DocASAP scheduling platform will have self-scheduling enabled in the UnitedHealthcare Medicare Member Portal. Included in the first phase of this pilot are Medicare Advantage (MA), Medicare Advantage Prescription Drug (MAPD), Sponsored Supplemental Plan (SSP), Dual Special Needs Plan (D-SNP), Chronic Special Needs Plan (C-SNP) and Institutional Special Needs Plan (I-SNP) members.
The Centers for Medicare & Medicaid Services (CMS) requires all special needs plans (SNPs) to provide initial and annual Model of Care (MOC) training to network providers contracted to see SNP members and out-of-network providers who routinely see SNP members.
The early and periodic screening, diagnostic and treatment (EPSDT) screening benefit of UnitedHealthcare Community plan helps provide comprehensive and preventative health care services for children from birth through age 20.
UnitedHealthcare Community Plan network care providers in Tennessee have access to AristaMD, a service that can help make specialty care appointments for members. This service can help save your staff time and help your patients get the specialty care they need.
As of Jan. 1, 2022, all TennCare CHOICES in Long Term Services (CHOICES) and Employment and Community First (ECF) providers must use the reportable event management (REM) process developed by the Department of Developmental Disabilities (DIDD) and TennCare.
Effective May 1, 2022, prior authorization is required when prescribing certain drugs for UnitedHealthcare Community Plan of Texas members to treat neuromyelitis optica spectrum disorder, eczema and migraines.
Effective April 1, 2022, bill claims for Star Kid (Medicaid) members with Medicare benefits to Medicare first. Then, unless the service is exempted, bill the Texas Medicaid & Healthcare Partnership (TMHP) for secondary payment to avoid denials.
A recent review has shown that some phone numbers in our network directory are incorrect. Accurate directory information helps ensure members can find care. Please review, update and attest that all practice phone numbers, and other demographics, are correct.
The Virginia Medicaid agency will launch a new technology platform in April 2022. Providers credentialed in 1 or more managed care organizations will use the new Provider Services Solution (PRSS) to complete enrollment and maintenance processes. This change is part of the Medicaid Enterprise System (MES) project.
The Centers for Medicare & Medicaid Services (CMS) recently announced changes to claim processing requirements that affect using Requests for Anticipated Payments (RAPs) for home health care claims, including changes to submission timelines and late penalties.
For claims processed on or after March 1, 2022, vitamin D screening CPT codes 82306, 82652 or 0038U will only be covered for UnitedHealthcare commercial members diagnosed with one of the listed diagnosis codes in the medical policy.
Starting April 1, 2022, UnitedHealthcare will no longer mail prior authorization and clinical letters to network providers and facilities in: Alaska, Arizona , California, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Washington and Wyoming.
Our 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.
This 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.
UnitedHealthcare 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.
UnitedHealthcare 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.
The 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.
UnitedHealthcare 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.
Starting 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.
This pharmacist-led program evaluates medication therapy for indication, effectiveness, safety and the patient’s ability to take their medications as prescribed. We use data obtained through pharmacy claims, medical claims and self-reporting.