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New 2022 Medicare benefit
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.
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.
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
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.
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.
Oct. 1, 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.
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.
Oct. 1, 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.
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.
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.
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.
Feb. 25, 2022
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
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
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 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.
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
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.
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
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
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.
Feb. 1, 2022
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
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
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.
Feb. 2, 2022
Now available: 2022 patient experience guidebookThe 2022 patient experience guidebook is now live on UHCprovider.com.
Mar. 19, 2022
New 90-day demographic verification requirementBeginning Jan. 1, 2022, UnitedHealthcare will require contracted health care professionals to verify their demographic information for accuracy every 90 days, instead of 120 days.
January 1, 2022
Your 2022 Administrative Guide is readyThis update is for commercial and Medicare plans
Apr. 1, 2022
Alabama: Home health review process changesStarting 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).
Apr. 1, 2022
Arizona: New resources available for family and professional caregivers of vulnerable individualsGet access to training, events, counseling, and more, for families and professional caregivers of people with intellectual or developmental disabilities.
Apr. 1, 2022
Arizona: Updated EPSDT clinical sample templates available nowUpdated versions of Arizona Health Care Cost Containment System (AHCCCS) Early and Periodic Screening, Diagnostic and Treatment (EPSDT) clinical sample templates are now available.
Feb. 17, 2022
Arizona: Appointment availability surveysThe 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).
Mar. 17, 2022
Arizona: Clinical toolkits to support behavioral health screenings and referralsArizona 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).
Feb. 17, 2022
Arizona Medicaid: Use the correct place of service code to avoid claim denials for telehealth servicesTo avoid a claim denial, ensure you’re using the correct place of service (POS) code when providing telehealth services for UnitedHealthcare Community Plan members.
Apr. 21, 2022
Arizona Medicaid: New care option for infants with neonatal abstinence syndromeUnitedHealthcare Community Plan of Arizona has contracted with Hushabye Nursery to better serve newborns with neonatal abstinence syndrome (NAS) and pregnant women with opioid use disorder (OUD).
January 14, 2022
Arizona: New School POS Billing GuidelinesThe Arizona Health Care Cost Containment System (AHCCCS) updated its billing guidance for school place of service.
Mar. 1, 2022
Arizona Medicaid: Resources to support the delivery of trauma-informed careLearn about state and national resources about trauma-informed care, including training for health care professionals.
January 14, 2022
Redirect messages for Bind added to the UnitedHealthcare Provider PortalIn order to check information, health care professionals must visit the UnitedHealthcare Shared Services (UHSS) Provider Portal at UHSS.UMR.com — not the UnitedHealthcare Provider Portal.
Feb. 1, 2022
Central/Southeast/Northeast regions: Prior authorization and clinical decision letters are going paperlessStarting 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.
Apr. 1, 2022
California Medicaid: Access a patient list of members without a required blood screeningA list of UnitedHealthcare Community Plan members who have yet to receive a required blood screening is now included in the Patient Care Opportunity Report (PCOR).
Mar. 17, 2022
California: Alcohol and drug screening requirements for primary care providersCalifornia 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 services.
May 1, 2022
Understanding Care CashThe prepaid debit card program helps eligible plan members with out-of-pocket expenses.
Feb. 1, 2022
Michigan: Updates to the 2022 Care Management and Quality Incentive Program for UnitedHealthcare Community Plan Primary Care Physicians (PCPs)Starting Jan. 1, 2022, we have updated the 2022 Care Management and Quality Incentive Program for Michigan. See the updates and how they impact your practice.
May 1, 2022
Colorado: Medical claim-related letters going paperless starting August 5On Aug. 5, 2022, commercial and Medicare Advantage plan claim letters for Colorado health care professionals/facilities are going paperless. View using API, or in Document Library or TrackIt.
Apr. 1, 2022
Colorado, Kentucky and Tennessee: New home health review processStarting July 1, 2022, for UnitedHealthcare® Medicare Advantage and Dual Special Needs Plans (D-SNP), you’ll need to request prior authorization for all visits after the start of care (SOC) visit.
Apr. 21, 2022
Commercial plans: Coverage change for DexilantEffective May 1, 2022, Dexilant®, a proton pump inhibitor (PPI), will be excluded from coverage for UnitedHealthcare commercial pharmacy plans.
January 1, 2022
UnitedHealthcare Community Plan preferred drug list updateBeginning 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.
Mar. 1, 2022
Act now to become a Designated Diagnostic Provider for ImagingInformation 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.
January 1, 2022
Refer your patients to a Designated Diagnostic Provider for lab servicesE & I health care professionals, please refer your patients to a Designated Diagnostic Provider for lab services to help avoid unnecessary costs for lab services.
Apr. 21, 2022
Earn CME credits and help improve patient experienceDetails on training modules for delivering excellent patient experience.
January 7, 2022
Virtual education sessions on new and expanded plansJoin our webinar to learn about expanded commercial, Medicare and retirement plans for members in Colorado, Idaho, Montana, Utah and Wyoming.
May 9, 2022
Electronic payments required for claim payments starting June 1Effective 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.
January 1, 2022
Exchange plans: Prior authorization updates for radiation and chemotherapy servicesStarting 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.
January 11, 2022
Payment change for Medicare Supplement member deductiblesA new UnitedHealthcare service will pay the Medicare Supplement member’s deductible responsibility automatically to you.
Feb. 1, 2022
Free CMEs: Buprenorphine and pregnancyFree on-demand CMEs: Buprenorphine and pregnancy Help reduce rates of Neonatal Abstinence Syndrome (NAS) and improve birth outcomes.
May 19, 2022
Florida: Complete the Obstetrical Risk Assessment Form to earn an incentiveEarn an incentive when you submit an Obstetrical Risk Assessment Form (OBRAF) for UnitedHealthcare Community Plan patients.
January 1, 2022
Shared Services Updates for GEHAEffective 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.
January 21, 2022
Genetic prior authorization waiver has expiredThe penalty waiver for genetic testing prior authorization requests has expired. Ordering providers must request prior authorization using the Prior Authorization and Notification platform.
Apr. 1, 2022
Hawaii: CME-Eligible Vaccine Hesitancy Training Now AvailableIn 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.”
Feb. 10, 2022
Hawaii: Vaccine hesitancy course now availableThe Vaccine Hesitancy Training course was developed collaboratively between Ohana, AlohaCare, Kaiser, HMSA and UnitedHealthcare.
Mar. 1, 2022
Home health review process changesStarting 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.
Feb. 1, 2022
Hospital Measures OverviewLearn more about hospital measures with our new self-paced course Hospital Measures Overview.
Feb. 1, 2022
New online course for providers treating patients with IDDA new online course for providers who serve individuals with intellectual and developmental disabilities (IDD) is available now.
January 21, 2022
Internet Explorer 11 users: Change your web browser to maintain UHCprovider.com and portal accessStarting 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.
January 1, 2022
Indiana: New outpatient injectable drug requirementsEffective April 1, 2022, we will require prior authorization for the medications listed in the table below for UnitedHealthcare Community Plan of Indiana members.
Apr. 1, 2022
Medicaid: Effective June 1, new prior authorization codes added in more statesEffective June 1, 2022, we’re adding new codes to the prior authorization list for cardiovascular procedures, prostate procedures, spine surgery and cosmetic surgery procedures.
Feb. 1, 2022
Medicaid: Injectable chemotherapy prior authorization updatePrior authorization for injectable chemotherapy is now required for UnitedHealthcare Community Plan members in Kansas and Virginia.
Apr. 1, 2022
Kentucky: Updating incarceration release dates in KYMMISMedicaid 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.
Apr. 21, 2022
Kentucky Medicaid: Schedule post-discharge appointments after inpatient hospitalization to help improve health outcomesFor 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.
Apr. 14, 2022
Louisiana Medicaid: Breast milk storage bags are now covered as durable medical equipmentEffective 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.
Apr. 21, 2022
New enrollment requirement for Louisiana MedicaidAll health care professionals who file claims with Louisiana Medicaid must enroll in the new Medicaid Provider Enrollment Portal byJune 30, 2022, to continue being reimbursed for services.
Apr. 21, 2022
Louisiana: New prior authorization codes for UnitedHealthcare Community PlansEffective August 1, 2022, you’ll see new codes on the prior authorization list for cardiovascular, prostate, spine, and cosmetic surgery procedures.
May 6, 2022
Louisiana Medicaid: Policy updates from the Louisiana Department of HealthThe Louisiana Department of Health has shared policy updates regarding COVID-19 monoclonal treatment, cardiovascular services and cochlear implants.
Apr. 1, 2022
Louisiana Medicaid: Review state policy on sinus procedures and surgeryThe Louisiana Department of Health issued Information Bulletin 22-3 announcing its policy on sinus procedure balloon ostial dilation and functional endoscopic sinus surgery effective March 9, 2022.
May 19, 2022
Louisiana Medicaid: Updated urine drug testing policy from the Louisiana Department of HealthEffective 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.
Apr. 5, 2022
Louisiana Department of Health COVID-19 temporary measuresSummary of the Louisiana Department of Health (LDH) exceptions to temporary measures in place due to COVID-19.
Mar. 17, 2022
Maryland: Follow the appeal and grievances submission process to help ensure timely responseTo maintain efficient turnaround times for appeals and grievance submissions, Maryland Medicaid providers must submit appeals and grievances through the proper channels.
Feb. 1, 2022
Maryland: Doula services now covered for Medicaid membersStarting Feb. 7, 2022, we will cover doula services for Maryland Medicaid members. Enroll with Maryland Medicaid before obtaining an agreement with UnitedHealthcare Community Plan.
Feb. 17, 2022
Annual audit for Maryland Healthy Kids EPSDT launching soonUnitedHealthcare 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.
January 14, 2022
Medicaid: New therapy prior authorization requirements in MarylandPrior authorization is required for occupational therapy, physical therapy and speech therapy for UnitedHealthcare Community Plan of Maryland members starting May 1, 2022.
January 1, 2022
Notice of change to review process related to cardiovascular codes that require prior authorization codesBeginning April 1, 2022, the entire claim will be denied if outpatient cardiovascular prior authorizations are not received or denied due to lack of medical necessity for Medicare Advantage plans.
May 6, 2022
Medicaid: Charging patients for non-covered servicesThe 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.
Feb. 17, 2022
New Medicare Advantage prior authorization requirement resources availableA 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.
May 19, 2022
UnitedHealthcare Community Plan: What to expect during a site visitHealth care professionals who wish to contract with UnitedHealthcare Community Plan may need a site visit as part of the credentialing process.
January 21, 2022
Medical PRAs won’t be mailed in 2022Effective 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.
January 10, 2022
New 2022 Medicare benefitA 100-day supply of medications is now available in 22 states for the same copay as a 90-day supply.
May 18, 2022
Michigan Medicaid: What you need to know about caring for members with hepatitis CThe 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.
Apr. 1, 2022
Minnesota Medicaid: Injectable chemotherapy prior authorization updateEffective 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.
May 1, 2022
Minnesota Medicaid: New prior authorization requirement for cognitive rehabilitationEffective 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.
May 1, 2022
Missouri: Health Homes training now availableHealth 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.
Apr. 1, 2022
Medical Policy Update Bulletins: April 2022Medical policy updates for April 2022 for the following plans: Medicare, Medicaid, Exchanges, and Commercial.
Feb. 1, 2022
Medical Policy Update Bulletins: February 2022Medical policy updates for February 2022 for the following plans: Medicare, Medicaid, Exchanges, and Commercial.
January 1, 2022
Medical Policy Update Bulletins: January 2022Medical policy updates for January 2022 for the following plans: Medicare, Medicaid, Exchanges, and commercial.
Mar. 1, 2022
Medical Policy Update Bulletins: March 2022Medical policy updates for March 2022 for the following plans: Medicare, Medicaid, Exchanges, and Commercial.
May 1, 2022
Medical Policy Update Bulletins: May 2022Medical policy updates for May 2022 for the following plans: Medicare, Medicaid, Exchanges, and Commercial.
Feb. 1, 2022
Change in post-acute care managementStarting April 1, 2022, naviHealth will manage post-acute care for UnitedHealthcare Institutional-Equivalent Special Needs Plans (IE-SNP) members.
Apr. 1, 2022
North Carolina: Avoid denials when submitting personal care services claimsAs a provider offering personal care services (PCS) to UnitedHealthcare Community Plan members, there are several actions you can take to help avoid claim denials for personal care services.
Apr. 19, 2022
North Carolina: Submit required sterilization consent and child medical evaluation forms for claims using Smart EditsEffective 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.
Apr. 20, 2022
Nebraska Medicaid: Temporary per diem rate increase for nursing and assisted living facilitiesNebraska Medicaid is increasing per diem rates by $20 per day for nursing and assisted living facilities for dates of service between Jan. 1, 2022, and June 30, 2022.
May 19, 2022
Nebraska: Improve future pregnancy outcomes by talking to your patients about the risks of tobacco useUnitedHealthcare has partnered with the Nebraska Perinatal Quality Improvement Collaborative (NPQIC) to reduce prematurity rates in Nebraska.
Feb. 1, 2022
New Jersey: Reimbursement changes to drug screening and testingEffective April 1, 2021, we made changes to presumptive drug screening and definitive drug testing reimbursement and CPT® codes for the UnitedHealthcare Community Plan of New Jersey.
Feb. 7, 2022
New Jersey Medicaid: Avoid denials when submitting multiple birth claimsEffective Dec. 1, 2021, multiple birth claims must be submitted with a valid condition code to be reimbursed.
Feb. 17, 2022
Taxonomy codes now required for New Jersey Medicaid claimsEffective for dates of service starting Dec. 1, 2021, UnitedHealthcare Community Plan of New Jersey is enforcing the taxonomy code requirement for all Medicaid claims submissions.
Apr. 21, 2022
New Jersey: New prior authorization codes for UnitedHealthcare Community Plans (Medicaid and Long-Term Care plans)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.
May 1, 2022
New Jersey Medicaid: Radiation therapy prior authorization updates effective July 1Effective July 1, 2022, prior authorization will be required for certain outpatient radiation therapies for UnitedHealthcare New Jersey Community Plan Medicaid members.
May 1, 2022
Medicaid: Changes to outpatient prior authorization process for non-oncology drugsEffective Aug. 1, 2022, Optum will manage prior authorization requests for non-oncology injectable medications that are covered on the medical benefit for UnitedHealthcare Community Plans.
May 1, 2022
New York Ambulatory Patient Groups guidelines to be enforced starting Aug. 1, 2022Effective Aug. 1, 2022, UnitedHealthcare Community Plan New York will start enforcing Ambulatory Patient Groups (APG’s) guidelines as published by the New York State Department of Health.
Apr. 21, 2022
New York Medicaid: New claims submission process saves you timeIn the coming months, you’ll submit claims for Medicaid beneficiaries to UnitedHealthcare Community Plan only, instead of sending them to us and to the Centers for Medicare & Medicaid Services (CMS).
Apr. 21, 2022
New York State Empire Plan: You can now verify and attest to your demographic information using CAQHCommercial 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.
Apr. 21, 2022
New York Medicaid: Updated MAT formulary effective as of March 22, 2022As of March 22, 2022, an updated single statewide medication assisted treatment (MAT) formulary is in effect.
May 1, 2022
New York Medicaid: DMEPOS Limit Policy enforcement begins Aug. 1Effective Aug. 1, 2022, we will start enforcing Durable Medical Equipment, Prosthetics, Orthotics, and Supplies policy as published by the New York State Department of Health.
May 1, 2022
New York: Coordinating and providing services for children and youth in foster careYou 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.
Feb. 17, 2022
New York Medicaid: Providers may be responsible for coordinating services for foster careUnitedHealthcare network providers may be responsible for providing and/or coordinating services for children/youth in direct placement foster care and in the care of Voluntary Foster Care Agencies.
Feb. 17, 2022
New York Medicaid: Complete the obstetrical risk assessment form to earn an incentiveNetwork care providers can now earn a $25 incentive for completing the obstetrical risk assessment form (OBRAF) within 5 days of a UnitedHealthcare Community Plan member’s first prenatal care visit.
Mar. 17, 2022
Oxford New York: Gastroenterologists must use Oxford participating anesthesiologistsParticipating gastroenterologists located in New York performing non-emergent procedures with anesthesia in-office or in ambulatory surgery centers must use an Oxford participating anesthesiologist.
January 1, 2022
New York: Prior authorization won’t be required for palonosetronPrior authorization will not be required for the anti-emetic drug palonosetron.
Apr. 1, 2022
New York: Review Medicaid policy details for SD and ED prescriptions and treatmentsAs 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).
Feb. 10, 2022
Observation notifications are no longer required for most plansAs of Dec. 1, 2021, for most plans, providers are no longer required to submit observation notification after a patient has been discharged home from observation level of care.
Mar. 1, 2022
Ohio: Access resources that may help change the lives of your diabetes patientsIntroducing a new resource tool to support your work in caring for patients in Ohio with diabetes.
Apr. 1, 2022
Updates to the oncology specialty pharmacy requirement for commercial plan membersMedication sourcing requirements removed for 5 oncology-supportive drugs for commercial plan members.
Apr. 1, 2022
New outpatient procedure grouper mapping exhibits for 2022Effective July 1, 2022, we’re updating the outpatient procedure grouper (OPG) mapping exhibits to reflect the codes that are eligible for reimbursement for outpatient procedures and other services.
January 21, 2022
Outpatient Procedure Grouper mapping updateOur updated 2021 UnitedHealthcare Outpatient Procedure Grouper (OPG) Exhibit is available at UHCprovider.com/claims.
January 1, 2022
New phone number for OrthoNet OxfordStarting 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.
Feb. 1, 2022
Updates for Oxford policies, prior authorizations and claimsUnitedHealthcare Oxford will have prior authorization and specialty pharmacy changes effective May 1, 2022.
May 1, 2022
Oxford Health Plans: Medical PRAs won’t be mailed after JulyBeginning in August 2022, medical PRAs will no longer be mailed for members covered by all Oxford Health Plans® in the states of CT, NJ and NY.
Feb. 1, 2022
Oxford specialty pharmacy requirement May 1, 2022UnitedHealthcare Oxford will have a specialty pharmacy requirement effective May 1, 2022.
May 16, 2022
Pennsylvania Medicaid: Billing updates for personal care servicesThe 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.
Mar. 17, 2022
New enhancements make prior authorization and notifications easierTwo 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.
Mar. 17, 2022
Patient self-scheduling via DocASAP launching March 31, 2022Starting March 31, 2022, health care professionals connected to the DocASAP scheduling platform will be ready for patient self-scheduling.
May 19, 2022
Explore resources to help you improve claims and payment accuracyAnnouncing a new Payment Accuracy web page to help providers submit claims and receive accurate payments.
January 1, 2022
Now accepting applications for the Preferred Lab NetworkApplications for the 2022 UnitedHealthcare Preferred Lab Network are now open.
Apr. 1, 2022
April 2022 policy and protocol updates overviewReview the latest UnitedHealthcare prior authorization, medical policy, pharmacy, reimbursement, laboratory and policy and protocol updates.
Feb. 1, 2022
February 2022 policy and protocol updates overviewReview the latest UnitedHealthcare prior authorization, medical policy, pharmacy, reimbursement, laboratory and policy and protocol updates.
January 1, 2022
January 2022 policy and protocol updates overviewReview the latest UnitedHealthcare prior authorization, medical policy, pharmacy, reimbursement, laboratory and policy and protocol updates.
Mar. 1, 2022
March 2022 policy and protocol updates overviewReview the latest UnitedHealthcare prior authorization, medical policy, pharmacy, reimbursement, laboratory and policy and protocol updates.
May 1, 2022
May 2022 policy and protocol updates overviewReview the latest UnitedHealthcare prior authorization, medical policy, pharmacy, reimbursement, laboratory and policy and protocol updates.
May 19, 2022
Discover how the UnitedHealthcare Provider Portal makes administrative work faster and easierMake administrative work easier. Create a One Healthcare ID to use the portal to: view eligibility, benefits, and payments, submit prior authorizations and claims, and attest to your data.
Mar. 1, 2022
Coverage changes for prenatal ultrasoundsPrenatal ultrasound coverage changes for UnitedHealthcare commercial members. This coverage is for professional claims only in a non-ER or inpatient setting.
May 1, 2022
Coverage changes for prenatal ultrasoundsStarting July 1, 2022, there’s a new obstetrical ultrasound medical policy for UnitedHealthcare Individual Exchange plan members.
Mar. 1, 2022
Radiology and cardiology CPT® codes added to prior authorization and notification list, effective June 1Effective 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.
Mar. 1, 2022
New radiation therapy prior authorization requirementsPrior authorization will be required for some outpatient radiation therapies.
Apr. 21, 2022
Training available: Therapeutic Radiation Prior Authorization programTraining available on May 18, 2022, to help providers navigate the new notification/prior authorization request process for outpatient radiation oncology therapies.
May 1, 2022
Risk Adjustment Data Validation audit program launching in June for randomly selected enrolleesIn 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.
Apr. 1, 2022
Reimbursement Policy Update Bulletins: April 2022You can review the details on April's reimbursement policy updates through the commercial, Medicare, Medicaid and Exchange plan bulletins.
Feb. 1, 2022
Reimbursement Policy Update Bulletins: February 2022You can review the details on February’s reimbursement policy updates through the commercial, Medicare, Medicaid and Exchange plan bulletins
January 1, 2022
Reimbursement Policy Update Bulletins: January 2022You can review the details on January’s reimbursement policy updates through the commercial, Medicare, Medicaid and Exchange plan bulletins
Mar. 1, 2022
Reimbursement Policy Update Bulletins: March 2022You can review the details on March's reimbursement policy updates through the commercial, Medicare, Medicaid and Exchange plan bulletins.
May 1, 2022
Reimbursement Policy Update Bulletins: May 2022You can review the details on May's reimbursement policy updates through the commercial, Medicare, Medicaid and Exchange plan bulletins.
Apr. 1, 2022
Specialty Medical Injectable Drug Program updates: April 2022Specialty Medical Drug Program updates for UnitedHealthcare Commercial, Community Plan, Medicare Advantage, and Value & Balance Exchange plans for April 2022.
Feb. 1, 2022
Specialty Medical Injectable Drug Program updates: February 2022Specialty Medical Drug Program updates for UnitedHealthcare Commercial, Community Plan, Medicare Advantage, and Value & Balance Exchange plans for February 2022.
January 1, 2022
Specialty Medical Injectable Drug Program updates: January 2022Specialty Medical Drug Program updates for UnitedHealthcare Commercial, Community Plan, Medicare Advantage, and Value & Balance Exchange plans for January, 2022.
Mar. 1, 2022
Specialty Medical Injectable Drug Program updates: March 2022Specialty Medical Drug Program updates for UnitedHealthcare Commercial, Community Plan, Medicare Advantage, and Value & Balance Exchange plans for March 2022.
May 1, 2022
Specialty Medical Injectable Drug Program updates: May 2022Specialty Medical Drug Program updates for UnitedHealthcare Commercial, Community Plan, Medicare Advantage, and Value & Balance Exchange plans for May 2022.
January 1, 2022
Introducing member self-scheduling pilot program using DocASAPStarting 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.
Apr. 1, 2022
Action required: 10-minute Model of Care trainingThe 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.
Apr. 1, 2022
Specialty Pharmacy Requirement updates for certain medical benefit medicationsThe specialty pharmacy requirements for UnitedHealthcare and Oxford commercial plan members were revised effective for dates of service on or after July 1, 2022.
Apr. 1, 2022
Tennessee: What you need to know about EPSDT screeningsThe 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.
May 4, 2022
Tennessee Medicaid: Save time and help your patients access specialty careUnitedHealthcare 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.
Apr. 1, 2022
Tennessee: Review the latest criteria for reportable eventsAs 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.
May 19, 2022
Texas: Changes to CHIP copayments for Mental Health and Substance Use Disorder ServicesEffective July 1, 2022, Texas Health and Human Services is prohibiting copayments for Children’s Health Insurance Program Mental Health and Substance Use Disorder Services.
Apr. 21, 2022
Texas Medicaid: Prepare for upcoming review of infusion and injection claimsEffective Aug. 1, 2022, if an outpatient facility submits a claim for administering an infusion or injection to a UnitedHealthcare Community Plan member, we’ll deny the claim.
May 1, 2022
Texas Medicaid claims: Service facility National Provider Identifier requirementThe Texas Medicaid & Healthcare Partnership (TMHP) requires a National Provider Identifier (NPI) on CMS-1500 and UB-04 claim submissions forms. Learn more and see exceptions.
May 19, 2022
UnitedHealthcare working to complete Texas direct payment program implementation by June 1, 2022Texas Health and Human Services Commission (HHSC) announced 4 new directed payment programs with a program effective date of Sept. 1, 2021.
Apr. 1, 2022
Texas Medicaid: Prior authorization changes starting May 2022Effective 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.
Feb. 22, 2022
Claims process change for Texas STAR Kids (Medicaid) members with Medicare benefitsEffective 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.
January 1, 2022
Medicaid: New prior authorization codes in select statesUpdate to prior authorization codes for cardiovascular, prostate, spine and cosmetic procedures in certain states for UnitedHealthcare Community Plan members.
May 1, 2022
Update your phone number in our network directoryA 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.
May 19, 2022
Virginia: New programs to promote patient health and wellnessNew Virginia plan benefits can help support efforts to promote overall patient health including vaccine incentives, fitness programs, and mental health and wellness support.
Apr. 21, 2022
Virginia: MES update for managed care-only network providersTo ensure a smooth process, DMAS is scheduling enrollments in MES in phases for managed care-only providers.
January 6, 2022
Virginia: New technology for Medicaid enrollment and maintenanceThe 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.
Apr. 1, 2022
Veteran’s Affairs Community Care Network home health updatesThe 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.
January 1, 2022
New coverage determinations for Vitamin D testingFor 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.
Feb. 1, 2022
Help improve behavioral health outcomes for your patientsFor 2022, Washington Medicaid is implementing mental health and substance use disorder clinical quality measures to help improve behavioral health outcomes for Medicaid beneficiaries.
January 21, 2022
Washington: Find local health care professionalsYou can find a local health care professional using our online Find Dr. directory.
January 1, 2022
West region: Prior authorization and clinical letters are going paperlessStarting 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.
Mar. 17, 2022
Wisconsin: Interim payment for long length of stayMembers of the UnitedHealthcare Community Plan of Wisconsin must be admitted as an inpatient at least 60 days before hospitals can submit claims for long length of stay.
January 21, 2022
FAQ available to support molecular diagnostic testing Z-Code requirementUnitedHealthcare Medicare Advantage requires providers in a Medicare jurisdiction that has implemented the MolDX program to submit the appropriate DEX Z-Code™ for molecular diagnostic test services.
May 16, 2022
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.
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.
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).
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.
January 13, 2022
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.
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.
Nov. 15, 2021
Change in post-acute care managementEffective April 1, 2021, naviHealth will manage post-acute care for Medicare Advantage members in additional markets.
May 19, 2022
New clinical pharmacist-led medication optimization programThis 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.
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 patie