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Nov. 14, 2019

12/2019: UnitedHealthcare Preferred Lab Network Inviting Labs to Apply

The annual application process for admission to the UnitedHealthcare Preferred Lab Network is now open.

Nov. 14, 2019

12/2019: OptumRx Retiring Fax Numbers Used for Pharmacy Prior Authorizations on Dec. 31

OptumRx® is going digital and will retire fax numbers used to submit pharmacy prior authorization requests on Dec. 31, 2019.

Nov. 22, 2019

12/2019: Enhancements Help Streamline Prior Authorization

We’ve made enhancements to our Prior Authorization and Notification tool on Link to improve the online submission process.

Nov. 14, 2019

12/2019: New Online Peer-to-Peer Scheduling Request Form Available In Mid-December

To help simplify the peer-to-peer scheduling process, we’ve updated our Peer-to-Peer Scheduling Request form with the ability to submit directly from the website.

Nov. 22, 2019

12/2019: UnitedHealthcare Will Reward Care Providers through Cancer Program

The new Cancer Therapy Pathways Program promotes the use of evidence-based and cost-effective regimens.

Dec. 19, 2019

01/2020: Prepare Today for Patients with Bind On-Demand Health Insurance

On Jan. 1, 2020, Bind on-demand health insurance will be available to all UnitedHealthcare employer groups across the nation.

Dec. 20, 2019

01/2020: HEDIS® 2020 Medical Record Collection Overview

Beginning in January 2020, we may contact you to request member-specific medical records.

Dec. 19, 2019

01/2020: Now Available: Individual Health Record™

We want to improve the health of every individual with UnitedHealthcare’s Individual Health Record.

Sept. 17, 2020

01/2020: UnitedHealthcare NexusACO® Benefit Plans Will Expand Access in 2020

Membership in the UnitedHealthcare NexusACO benefit plans is continuing to grow. Starting Jan. 1, 2020, even more members will have access to the UnitedHealthcare NexusACO plans.

Sept. 23, 2020

01/2020: Bringing You Smart Edits in the New Year

To support care providers in our network, UnitedHealthcare offers a claims optimization tool called Smart Edits.

Apr. 7, 2020

Get Ready for the CAHPS/HOS Season

Your patients may be participating in a survey initiative that may impact your care and interactions with them.

Feb. 2, 2020

MA Benefit Plans Expanding in 2020

This year our Medicare Advantage plans are expanding across 43 states, potentially boosting the impact you can have on patients near you.

Feb. 7, 2020

Hospital Reference Lab Protocol

Changes are being made May 1, 2020 to UnitedHealthcare commercial non-patient lab reimbursement requirements.

January 23, 2020

Prior Authorization Submission Enhancements

You can do more, faster with the new enhancements to our Prior Authorization and Notification (PAAN) tool on Link.

January 23, 2020

New Requirements for Percutaneous PFO Closure

Effective May 1, 2020, we’re introducing a required notification/prior authorization process for Percutaneous Patent Foramen Ovale (PFO) Closure for UnitedHealthcare commercial members.

Feb. 2, 2020

Enhance the Way You Prescribe Medicine

PreCheck MyScript® (PCMS) is a prescription price tool to help save time, reduce administrative tasks and may lower costs for your patients.

Feb. 28, 2020

Your Area of Expertise

Learn if an Area of Expertise has been added to your profile on UHCprovider.com. This helps patients find medical care providers who have experience, skills, or training in a particular area.

Feb. 28, 2020

Avella to Provide Infertility Medication

Starting March 1, 2020, all infertilely medication will be designated to Avella Specialty Pharmacy for OptumRx® and UnitedHealthcare Community Plan and commercial members.

Feb. 28, 2020

Additions to Cancer Therapy Pathways

Melanoma and colorectal cancers are now included in our Cancer Therapy Pathways program. Learn about participating plans, opportunities for rewards, training and more.

Feb. 28, 2020

Update to 2019–2021 Credentialing Plan

Effective June 1, 2020, we have made updates to our 2019 – 2021 Credentialing Plan regarding the requirements for facilities that include either accreditation or a site visit.

Feb. 28, 2020

Electronic Payment Solutions Rolling Out in 2020

Throughout 2020, we will launch initiatives to replace paper checks with electronic payments. Learn about your electronic payment options and opportunities.

Feb. 28, 2020

Prior Authorization and Notification Requirement Updates

We’re making changes to certain advance notification and prior authorization requirements. See the updated links and 2020 Summary of Changes.

Apr. 28, 2020

Coronary CTA Reimbursement Update

You can learn more about Coronary Computed Tomographic Angiograms (CTA) that are eligible for reimbursement in certain situations.

Apr. 24, 2020

COVID-19 Treatment Update

Learn more about how member cost sharing for the treatment of COVID-19 is being waived until May 31, 2020.

Apr. 29, 2020

Genetic and Molecular Prior Authorization

Prior authorization for genetic and molecular testing performed in an outpatients setting will now be required for California, Hawaii, Kansas, Nebraska, Ohio and Wisconsin.

Nov. 2, 2021

Prior Authorization and Site of Service Reviews

Beginning Aug. 1, 2020, Iowa will be in scope with specific outpatient surgical codes we announced in November 2019.

May 27, 2020

Care Management

Learn about what a United Healthcare Community Plan case manager can provide for your patients.

May 29, 2020

Catheter Ablation for Atrial Fibrillation

Additional CPT codes will be added to the prior authorization process for cardiac ablation for atrial fibrillation.

May 29, 2020

Genetic and Molecular Prior Authorization Update

You 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 Vault

Beginning Sept. 1, 2020, claims acknowledgement letters will be paperless.

Nov. 17, 2020

Laboratory Test Registration Requirement Coming Soon

Learn more about the laboratory test registration requirement that is coming for free-standing and outpatient hospital laboratory providers.

May 26, 2020

Lower Extremity Vascular Interventions

Medicare 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 Update

Effective July 1, 2020, Oxford Health Plan will have updates to their prior authorization and advanced notifications requirements.

Aug. 31, 2020

Policy, Protocol and Program Delays (Full List)

This is the complete list of delays communicated in the May and June 2020 Network Bulletin.

June 23, 2020

3rd Quarter 2020 Preferred Drug List Update

See what’s changed for this quarters preferred drug list.

May 26, 2021

Oxfordhealth.com Provider Portal Login Change

See the login change being made to Oxfordhealth.com.

June 30, 2020

Preferred Lab Network Expansion

See the latest additions to our Preferred Lab Network.

Nov. 19, 2020

Prior Authorization and Site of Service Reviews

Utah will be excluded from some prior authorization requirements and site of service medical necessity reviews.

June 29, 2020

Retiring Admission Notification Fax Numbers

Review your electronic options as fax numbers are retired.

June 25, 2020

Social Determinants of Health (SDoH) Protocol

Documenting SDoHh data using ICD-10 diagnostic code(s) is now needed.

Oct. 8, 2020

New, Streamlined Link Experience Launching in July

We’re creating a more streamlined Link experience.

July 31, 2020

Easy Access to Your Payments with Direct Deposit

We are phasing out paper payments, providing you with quick and easy electronic payments.

July 31, 2020

Cancer Therapy Pathways Program Opportunities

See that latest additions to the Cancer Therapy Pathways program.

July 31, 2020

Catheter Ablation for Atrial Fibrillation

This is an update for Iowa.

July 31, 2020

Change to Claim Denial Letters

Your claim denial letters will be consolidated, starting in November.

July 31, 2020

Provider Data Accuracy Requirements

If 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 Retiring

Review your electronic options and see the complete list of retiring fax numbers.

Aug. 25, 2020

Faster and Easier Online Credentialing

Introducing Onboard Pro, our new and improved credentialing tool.

Sept. 14, 2021

Out-of-Network Outpatient Benefit Update

There are new requirements around using out-of-network laboratories, dialysis centers and durable medical equipment (DME) providers.

July 31, 2020

UnitedHealth Premium® Program Details Now Available

Learn more about UnitedHealth Premium designation and key dates.

Nov. 19, 2020

Prior Authorization and Site of Service Reviews

See the expanding requirements for certain surgical procedures.

July 31, 2020

New Prescription Safety Edits

Learn what new Concurrent Drug Utilization Review (cDUR) edits are rolling out to pharmacies across the country.

July 31, 2020

New Type of Smart Edits

Learn more about Smart Edits so you can make the most of this claims processing tool.

Oct. 15, 2020

Texas Prior Authorization Update

Texas will adopt WellMed's prior authorization list, in some cases, for United Healthcare Medicare Advantage plans.

Aug. 31, 2020

Accessing Member Rosters Now Online Only

Learn more about CommunityCare tool and how you can see the member roster online.

Aug. 31, 2020

Billing Improvement for Multiple Home Health Visits

Performing three key steps to improve the payment process when billing for multiple home health visits just got easier.

Oct. 12, 2020

Document Vault – A Paperless Solution

Transition from paper to digital channels.

Aug. 31, 2020

New Inhaled Nitric Oxide Medical Policy

Florida will soon be in scope for the Community Plan New Inhaled Nitric Oxide Medical Policy.

Aug. 31, 2020

Genetic and Molecular Prior Authorization Update

This update is for Kansas and Ohio UnintedHealthcare Community Plan.

Aug. 31, 2020

Medicare Advantage Service Area Reductions 2021

Annual evaluations for Medicare Advantage plans may lead to service area reductions and plan terminations.

Sept. 21, 2021

New York Payment Policy Change

See that latest editions to the Cancer Therapy Pathways program.

Aug. 31, 2020

Prior Authorization and Site of Service Review

Some prior authorization and site of service reviews implementation dates are being delayed.

Nov. 19, 2020

Prior Authorization and Site of Service Review Update

Some prior authorization and site of service reviews implementation dates are being delayed.

Aug. 31, 2020

Retiring Admission Notification Fax Number Update

New electronic processes for Community Plan of Rhode Island newborn notifications and Community Plan of Washington Exception to Rule requests.

Aug. 31, 2020

More Streamlined Link Coming This Fall

TrackIt and referralLink will be added to your streamlined Link experience beginning this fall.

Aug. 31, 2020

Utah PRAs to Go Paperless

Utah provider payments for paper provider remittance advice (PRA) will no longer be printed and mailed.

Sept. 24, 2020

4th Quarter 2020 Preferred Drug List Update

UnitedHealthcare Community Plan’s Preferred Drug List (PDL) is updated quarterly by our Pharmacy and Therapeutics Committee.

Sept. 29, 2020

All Savers® Alternate Funding Plans Update

Learn more about the name change rolling out later this year.

Sept. 29, 2020

Cancer Therapy Pathways Program Opportunities

See what new pathway has been added to this program.

Sept. 28, 2020

Cancer Therapy Prior Authorization Update

Outpatient Injectable Cancer Therapy Prior Authorization requirements are being updated.

Sept. 30, 2020

Case and Disease Management Programs

These case and disease management programs are here to support you.

Sept. 29, 2020

New (ED) Professional (E/M) Coding Policy Update

The implementation date for medicare and commercial plans of the Emergency Department (ED) Professional Evaluation and Management (E/M) Coding Policy have been delayed.

Oct. 7, 2020

Member Cost Share Reimbursement Update

There are new requirements for 2021.

Oct. 7, 2020

Dual Complete: Members Matched with a Navigator

The UnitedHealthcare Dual Complete® plan will now pair our members with a Navigator.

Sept. 29, 2020

Exchange Plans Prior Authorization Information

Review this important information about Prior Authorization submission for our new Exchange Plans.

Sept. 30, 2020

New Exchange Plans Resources

Review important resources for the exchange plans launching in January 2021.

Sept. 29, 2020

Genetic and Molecular Prior Authorization Update

See what codes are being suspended from prior authorization and notification requirements.

Feb. 10, 2021

Hospital Policy Requirement Changes

In 2021, we are updating the requirements for our hospital discharge, observation stay and emergency department notifications policy.

Sept. 28, 2020

Medicare Member Rights and Responsibilities

You can share this information with your patients who are our members.

Sept. 28, 2020

Network Bulletin PDF Format Retiring

All your Network Bulletin updates are online at UHCprovider.com/networknews.

Sept. 28, 2020

New York Epidural Reimbursement Update

Learn more about what is changing to better align with state guidelines.

May 21, 2021

Online Behavioral Health Resources

There is online information for medical clinicians treating depression, substance use disorders and ADHD.

Sept. 29, 2020

Facility Reimbursement Policy Enhancement

The current policy is expanding in November 2020.

Sept. 29, 2020

Prior Authorization and Site of Service Update

Learn how we are expanding our requirements colonoscopy procedures.

Apr. 16, 2021

Radiology and Cardiology Urgent Request Update

Urgent requests for Radiology and Cardiology prior authorization and notification are getting easier.

Sept. 28, 2020

Radiology Program Procedure Code Changes

See what codes now require prior authorization.

Sept. 29, 2020

Tecartus Prior Authorization Requirement

Learn more about prior authorization requirements for Chimeric Antigen Receptor T-cell (CAR-T) Therapy.

Sept. 29, 2020

2021 Telehealth Policy Updates

Policy modifications for 2021 are making some members eligible for more telehealth services.

Sept. 29, 2020

2021 Telehealth Service Requirements

Get more information about telehealth requirements for 2021.

Oct. 29, 2020

Diagnosis and Treatment of ADHD

You can review these resources to help you diagnose ADHD.

Dec. 31, 2020

Clinical Fax Number Retirement on Feb. 1, 2021

As fax numbers retire, we have online tools to help support your requests.

Oct. 29, 2020

Computed Tomography Site of Service Update

Important update about site of service reviews.

Oct. 29, 2020

Credentialing Plan 2021–2023 Summary of Changes

You can see some of the key updates we are making in 2021.

Nov. 11, 2020

Important Exchange Plan Resources

More information is available regarding the Exchange plans launching in 2021.

Oct. 29, 2020

Lab Test Registration Requirement — Delay and Scope Update

The Laboratory Test Registration requirement is delayed for free standing and outpatient hospital lab providers.

January 12, 2021

Leuprolide Acetate Requires Prior Authorization

Learn more about where and when prior authorization will be required.

Oct. 29, 2020

Medicare Advantage 2021 Benefit Plan Expansion

See where you can find Medicare Advantage plans in 2021.

Oct. 29, 2020

Treatment for Members with Substance Use Disorders

Learn more about treatment for substance use disorder.

Nov. 30, 2020

Arkansas – Hospital Policy Requirement Changes

For Arkansas, this requirement does not go into effect until March 1, 2021.

Nov. 30, 2020

Cardiac Rehabilitation Utilization

Learn about the benefits of referring your patients and cost-share changes.

Nov. 30, 2020

Digital Tools Help Members Find You

Keeping your information up-to-date makes a difference.

Nov. 30, 2020

Important Exchange Plan Prior Authorization Update

See what codes will be required.

Nov. 30, 2020

Laboratory Test Registration Requirement – Delay Update

See what’s new with our lab test registration protocol.

Oct. 12, 2021

Malpractice Insurance Requirements Changing in 2021

Minimum coverage amounts are increasing for credentialing and recredentialing requirements

Mar. 4, 2021

New Referral Requirements for Our Medicaid Plans - New York

You can learn more about what will be required.

Nov. 30, 2020

Prescription Drug List Updates

The January 2021 updates are now available.

Nov. 30, 2020

Drug List Update – Specialty Pharmacies

You can see our expansion of the requirement to use participating specialty pharmacies for certain medications.

Nov. 30, 2020

Updated 2021 E/M Reimbursement Policy

You have access to the updated policy and coding support tools.

Nov. 30, 2020

Utah Transition to Digital PRAs Postponed

Utah from print and mail to digital solutions will be postponed to Feb. 1, 2021.

January 1, 2021

Clinical Fax Number Retirement on Feb. 1, 2021

Commercial | Medicare | Medicaid

As fax numbers retire, we have online tools to help support your requests.

January 1, 2021

Connecticut: Appointment Standards for Commercial Plans

Commercial

Please 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 Requirement

Commercial

Your EMR/EHR needs to integrate with our Preferred Lab Network.

January 1, 2021

Shared Services Updates for GEHA

Government 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 Expansion

Commercial

We will require prior authorization/notification for additional CPT codes.

January 1, 2021

Louisiana 2021 Pharmacy Network Optimization

Medicaid

On Jan. 15, 2021, UnitedHealthcare Community Plan in Louisiana will introduce a new pharmacy network.

January 1, 2021

Maryland: Appointment Standards for Commercial Plans

Commercial

Please 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 Update

Medicaid

PDL changes will be effective Jan. 1, 2021 for select UnitedHealthcare Community Plans.

January 1, 2021

Mental Health Referral Requirements Change for Mid-Atlantic

Commercial

Effective 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 2021

Commercial

You 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 Now

Commercial

Complete and return the Maternity Installment Payments Election form

January 1, 2021

New York Medicaid Prior Authorization Requirements Orthotics

Medicaid

Effective April 1, 2021, new codes will be added to the Prior Authorization List.

January 1, 2021

Outpatient Procedure Grouper Mapping Update

Commercial

Code updates are now available for 2021.

January 1, 2021

Hospital Reference Lab Protocol Changes

Commercial

These changes apply to Oxford plans.

January 1, 2021

Prior Authorization and Site of Service Review Update

Commercial | Medicare

See our clarification notice.

January 1, 2021

Radiation therapy prior authorization update

Exchange Plans

Review this update about prior authorization coverage for commercial members.

January 1, 2021

Reimbursement Policy Update Bulletins: January 2021

Commercial | Medicare | Medicaid | Exchange Plans

You can review the reimbursement policy update bulletins for our various health benefit plans.

January 1, 2021

Risk Adjustment Data Validation

Commercial | Exchange Plans

You and your team may have patients participating

January 1, 2021

Prior Authorization Requirement for Synagis® and Xolair®

Medicaid

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 Updates

Commercial | Medicare | Medicaid

See updates and learn about training with billing guidance.

Feb. 1, 2021

Arizona: Evidence-based guidelines transition

Medicaid

Effective May 1, 2021, UnitedHealthcare Community Plan of Arizona will be transitioning our evidence-based clinical care guidelines.

Feb. 1, 2021

Exchange plan prior authorization updates

Exchange Plans

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.

Feb. 1, 2021

UnitedHealthcare is transitioning to InterQual criteria

Commercial | Medicare | Medicaid | Exchange Plans

UnitedHealthcare 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®

Commercial | Medicare | Medicaid | Exchange Plans

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 Bulletin

Commercial | Medicare | Medicaid | Exchange Plans

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.

Feb. 1, 2021

Medical Policy Update Bulletins: February 2021

Commercial

You can review the medical policy update bulletins for our various health benefit plans.

Feb. 1, 2021

February 2021 Network Bulletin Overview

Commercial | Medicare | Medicaid | Exchange Plans

The 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 change

Medicaid

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).

Feb. 1, 2021

New prescription safety edits

Medicaid

To 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 2021

Commercial | Medicare | Medicaid | Exchange Plans

You can review the reimbursement policy update bulletins for our various health benefit plans.

Feb. 1, 2021

Specialty Medical Injectable Drug Program Updates: February 2021

Commercial | Medicare | Medicaid | Exchange Plans

Monthly update for the Specialty Medical Injectable Drug Program Bulletin.

Feb. 1, 2021

Skilled nursing facility consolidated billing requirements for Medicare Advantage plans

Medicare

Skilled nursing facilities (SNF) are required to use consolidated billing when submitting claims for post-acute inpatient SNF admissions for UnitedHealthcare Medicare Advantage members.

Feb. 1, 2021

Utah: Prior authorization and clinical letters will no longer be mailed

Commercial | Medicare | Medicaid | Exchange Plans

Effective May 1, 2021, we will no longer print and mail paper medical prior authorization and clinical letters to in-network health care professionals and facilities in Utah.

Feb. 1, 2021

VA CCN Provider Manual updates

VA CCN

Routine 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 Plans

Medicaid

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.

Mar. 1, 2021

Exchange plans: Prior authorization update

Exchange Plans

Additional prior authorization and notification requirements for Exchange plans launched January 1, 2021.

Mar. 1, 2021

Kansas: new outpatient injectable drug requirements

Medicaid

Effective 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 2021

Commercial

You can review the medical policy update bulletins for our various health benefit plans.

Mar. 1, 2021

March 2021 Network Bulletin overview

Commercial | Medicare | Medicaid | Exchange Plans

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.

Mar. 1, 2021

New Jersey: New utilization review time frames

Commercial

Effective June 1, 2021, initial utilization reviews for radiology, cardiology and radiation therapy in New Jersey will be adjusted to 72 hours for commercial plans.

Mar. 1, 2021

New York: National Drug Code reporting

Medicaid

Starting 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 requirement

Commercial

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.

Mar. 1, 2021

Radiology and cardiology prior authorization updates

Commercial | Medicare | Exchange Plans

Effective 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 2021

Commercial | Medicare | Medicaid | Exchange Plans

You 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 2021

Commercial | Medicare | Medicaid | Exchange Plans

Monthly update for the Specialty Medical Injectable Drug Program Bulletin.

Mar. 1, 2021

2nd quarter prescription drug list

Commercial

Commercial plan Prescription Drug List and Pharmacy Benefit Coverage Updates that will take effect May 1, 2021 are now available to view.

Apr. 1, 2021

Medical Policy Update Bulletins: April 2021

Commercial

You can review the medical policy update bulletins for our various health benefit plans.

Apr. 1, 2021

April 2021 Network Bulletin overview

Commercial

The April Network Bulletin includes updates for medical and reimbursement policy updates. Along with genetic and molecular testing prior authorization, anti-emetics prior authorization, Outpatient Procedure Grouper annual update and more.

Apr. 1, 2021

Reimbursement Policy Update Bulletins: April 2021

Commercial | Medicare | Medicaid | Exchange Plans

UnitedHealthcare April reimbursement policy updates for commercial, Medicare, Medicaid and Exchange plans.

Apr. 1, 2021

Specialty Medical Injectable Drug Program Updates: April 2021

Commercial | Medicare | Medicaid | Exchange Plans

Monthly update for the Specialty Medical Injectable Drug Program Bulletin.

May 1, 2021

Medical Policy Update Bulletins: May 2021

Commercial

Medical policy updates for May 2021 for the following plans: Medicare, Medicaid, Exchanges, commercial and commercial affiliates.

May 1, 2021

May 2021 Network Bulletin overview

Commercial | Medicaid | Exchange Plans | Medicare

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.

May 1, 2021

Reimbursement Policy Update Bulletins: May 2021

Commercial | Medicare | Medicaid | Exchange Plans

You 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 2021

Medicare | Commercial | Exchange Plans | Medicaid

Specialty 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 soon

Medicaid | Medicare | Commercial

We’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 request

Medicaid

Submitting 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 2021

Commercial

Medical 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 care

Medicaid

Beginning 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 overview

Commercial | Medicaid | Medicare | Exchange Plans

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.

June 1, 2021

Medicaid: New prior authorization codes in select states

Medicaid

We 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 delay

Commercial

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

June 1, 2021

Medicaid anti-emetic prior authorization update

Medicaid

Effective 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 2021

Commercial | Medicare | Medicaid | Exchange Plans

You 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 2021

Medicaid | Medicare | Commercial | Exchange Plans

Specialty 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 update

Commercial

The 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 updates

Exchange Plans

Starting 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 delayed

Commercial | Medicaid

In 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 list

Medicaid

The 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 Medicaid

Medicaid

There 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 2021

Commercial

Medical policy updates for July 2021 for the following plans: Medicare, Medicaid, Exchanges, and commercial.

July 1, 2021

July 2021 Network Bulletin overview

Commercial | Medicare | Medicaid | Exchange Plans

The 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 update

Medicaid

Effective Oct. 1, 2021, Optum will begin managing our prior authorization requests for outpatient injectable cancer therapy.

July 1, 2021

2021–2022 Preferred Lab Network expansion

Commercial | Medicaid

Specialty 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 2021

Commercial | Medicare | Medicaid | Exchange Plans

You 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 2021

Commercial | Medicare | Medicaid | Exchange Plans

Specialty 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 update

Commercial

Medications added to the Specialty Pharmacy Requirements Drug List for commercial plans

Aug. 1, 2021

Electronic payments required for UnitedHealthcare Community Plan of Arizona

Medicaid

We 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 update

Commercial

Starting 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 requirements

Medicaid

Beginning 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 care

Medicare

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.

Aug. 1, 2021

Medicaid: New facet injection codes for prior authorization in select states

Medicaid

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.

Aug. 1, 2021

Medical Policy Updates August 2021

Commercial

Medical policy updates for August 2021 for the following plans: Medicare, Medicaid, Exchanges, and commercial.

Aug. 1, 2021

August 2021 Network Bulletin overview

Commercial

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.

Aug. 1, 2021

New Jersey: Medicaid prior authorization requirements for certain therapy services

Medicaid

Effective 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 authorization

Medicaid

Here 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 Plan

Commercial

Effective 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 plans

Commercial

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).

Aug. 1, 2021

Reimbursement Policy Update Bulletins: August 2021

Commercial | Medicare | Medicaid | Exchange Plans

You 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 2021

Commercial | Medicare | Medicaid | Exchange Plans

Specialty Medical Drug Program updates for UnitedHealthcare Commercial, Community Plan, Medicare Advantage, and Value & Balance Exchange plans for August 2021.

Aug. 1, 2021

West Region: Medical provider remittance advice won’t be mailed after October

Commercial | Medicare | Medicaid | Exchange Plans

Starting Nov. 5, 2021, provider remittance advice (PRAs) for medical claims will no longer be mailed to in-network providers and facilities in the following states: Alaska, Arizona , California, Colorado , Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Washington and Wyoming.

Sept. 1, 2021

Medicare Advantage Service Area Reductions 2022

Medicare

Annual evaluations for Medicare Advantage plans may lead to service area reductions and plan terminations.

Sept. 1, 2021

Medical Policy Update Bulletins: September 2021

Commercial

Medical policy updates for September 2021 for the following plans: Medicare, Medicaid, Exchanges, and commercial.

Sept. 1, 2021

Mississippi: Electronic payments required for UnitedHealthcare Community Plan

Medicaid

We will no longer send paper checks for claim payments to Community Plan health care professionals in Mississippi.

Sept. 1, 2021

September 2021 Network Bulletin overview

Commercial | Medicare | Medicaid | Exchange 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.

Sept. 1, 2021

Pennsylvania and New Jersey: Hysterectomy prior authorization criteria change

Medicaid

Effective Nov. 1, 2021, UnitedHealthcare Community Plans (Medicaid, Long-Term Care) in New Jersey and Pennsylvania will have a criteria change to hysterectomy prior authorization CPT code 58573.

Sept. 1, 2021

Southeast and Central: Medical PRAs won’t be mailed after November

Commercial | Medicare | Medicaid | Exchange Plans

Starting Dec. 10, 2021, UnitedHealthcare provider remittance advice (PRAs) for medical claims will no longer be mailed to in-network providers and facilities in the following states: ND, SD, NE, KS, OK, TX, MN, IA, MO, AR, LA, WI, IL, MI, IN, OH, KY, TN, NC, SC, MS, AL, GA, FL. View in the portal, through Optum Pay or EDI.

Sept. 1, 2021

Radiology prior authorization updates

Commercial | Medicaid | Exchange Plans

Radiology prior authorization code updates for UnitedHealthcare Community Plan, commercial and Exchange

Sept. 1, 2021

Reimbursement Policy Update Bulletins: September 2021

Commercial | Medicare | Medicaid | Exchange Plans

You 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 2021

Commercial | Medicare | Medicaid | Exchange Plans

Specialty 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 Drugs

Commercial

UnitedHealthcare® 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 update

Commercial

Tufts Health Freedom Plan policy update for Massachusetts, Maine, New Hampshire, Vermont and Rhode Island.

Sept. 1, 2021

Texas: Maternal level-of-care reimbursement

Medicare

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).

Oct. 1, 2021

Genetic and molecular testing updates

Commercial | Exchange Plans

UnitedHealthcare will require prior authorization for additional genetic and molecular testing CPT® codes for commercial plan members.

Oct. 1, 2021

2022 UnitedHealthcare Individual Exchange plans

Exchange Plans

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.

Oct. 1, 2021

Kentucky: Prior authorization and site of service update

Commercial

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.

Oct. 1, 2021

Medicare: Prior authorization required for oncology anti-emetics

Medicare

Starting 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 authorizations

Medicare

UnitedHealthcare 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 drugs

Medicare

Starting 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 2021

Commercial

Medical policy updates for October 2021 for the following plans: Medicare, Medicaid, Exchanges, and commercial.

Oct. 1, 2021

October 2021 policy and protocol updates overview

Commercial | Medicare | Medicaid | Exchange Plans

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.

Oct. 1, 2021

New Jersey: 2022 referral update

Medicaid

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.

Oct. 1, 2021

New York: Update to injectable cancer therapy effective date

Medicaid

Effective Feb. 1, 2022, Optum will begin managing our prior authorization requests for outpatient injectable cancer therapy.

Oct. 1, 2021

Policy and protocol updates in 2022

Commercial | Medicare | Medicaid | Exchange Plans

Starting 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 2021

Commercial | Medicare | Medicaid | Exchange Plans

You 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 2021

Commercial | Medicare | Medicaid | Exchange Plans

Specialty 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 update

Commercial

Effective 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 Texas

Medicaid

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.

Nov. 1, 2021

Appeal decision letters won’t be mailed in 2022

Commercial

Beginning Feb. 11, 2022, most contracted medical providers will need to view Medicare Advantage (including Dual Special Needs) and commercial appeal decision letters online in Document Library or with API.

Nov. 1, 2021

Arizona: Changes to facet injection codes for prior authorization

Commercial

Starting 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 change

Commercial | Medicare | Medicaid | Exchange Plans

Prior 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 update

Commercial

The 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 authorization

Commercial

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.

Nov. 1, 2021

Changes to electrophysiology implant prior authorization

Commercial | Medicare | Medicaid | Exchange 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.

Nov. 1, 2021

New health plan for Massachusetts dual-eligible members

Medicare | Medicaid

UnitedHealthcare 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 2022

Medicare

In 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 benefit

Medicaid

Starting 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 expansion

Medicare

Starting May 1, 2022, for UnitedHealthcare Medicare Advantage plans, we’re expanding our prior authorization requirements and site of service medical necessity reviews for certain surgical procedures.

Nov. 1, 2021

Medicare new prior authorization requirement that includes clinical submission

Commercial | Medicare | Medicaid | Exchange Plans

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.

Nov. 1, 2021

Medical Policy Update Bulletins: November 2021

Commercial | Medicare | Medicaid | Exchange Plans

Medical policy updates for November 2021 for the following plans: Medicare, Medicaid, Exchanges, and commercial.

Nov. 1, 2021

Northeast: Medical PRAs going paperless in February

Commercial | Medicare | Medicaid | Exchange Plans

Starting Feb. 4, 2022, UnitedHealthcare will no longer mail provider remittance advice (PRAs) for medical claims to network providers and facilities in the following states: CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VA, VT and WV. View in the portal through Optum Pay or EDI.

Nov. 1, 2021

Nebraska: Heritage Health Adult benefit expansion

Medicaid | Exchange Plans

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.

Nov. 1, 2021

November 2021 policy and protocol overview

Commercial | Medicare | Medicaid | Exchange Plans

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.

Nov. 1, 2021

Prior authorization and site of service updates

Commercial | Exchange Plans

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.

Nov. 1, 2021

Prior authorization changes for private duty nursing

Medicare

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.

Nov. 1, 2021

Reimbursement Policy Update Bulletins: November 2021

Commercial | Medicare | Medicaid | Exchange Plans

You 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 2021

Commercial | Medicare | Medicaid | Exchange Plans

Specialty 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 update

Commercial

Effective 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 disclosure

Commercial | Medicare | Medicaid | Exchange Plans

UnitedHealthcare 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 Plan

Medicaid

UnitedHealthcare 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 services

Exchange Plans

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.

Dec. 1, 2021

New prior authorization requirements for Individual Exchange plans

Exchange Plans

Starting 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 update

Commercial

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.

Dec. 1, 2021

Medical Policy Update Bulletins: December 2021

Commercial | Medicare | Medicaid | Exchange Plans

Medical policy updates for December 2021 for the following plans: Medicare, Medicaid, Exchanges, and commercial.

Dec. 1, 2021

December 2021 policy and protocol updates overview

Commercial | Medicare | Medicaid | Exchange Plans

Prior 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 delay

Commercial | Exchange Plans

Effective 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 2021

Commercial | Medicare | Medicaid | Exchange Plans

You 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 2021

Commercial | Medicare | Medicaid | Exchange Plans

Specialty 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 2022

Medicaid

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.

Sept. 3, 2021

Support for health care professionals and members affected by severe weather and other emergencies

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.

Oct. 21, 2021

2020 Quality Improvement Program overview

Commercial

UnitedHealthcare maintains a Quality Improvement (QI) program to improve our members’ and providers’ health care experience. The following are the most important activities in our QI 2020 program for UnitedHealthcare commercial plans.

May 3, 2021

2021 National Nurses Week

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.

July 29, 2021

Use required 340B modifiers for accurate payment

CMS and UnitedHealthcare require a JG modifier on Medicare claims for separately payable, OPPS 340B drugs and biologics (status indicator K) to receive claims payment of ASP minus 22.5%.

Oct. 19, 2021

Take 5 minutes to update your telehealth details

Commercial | Medicare | Medicaid

Take 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 soon

Medicaid

Starting 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 registration

Medicaid

Referring, ordering, prescribing and attending providers: Update registration with the Arizona Healthcare Cost Containment System (AHCCCS).

Apr. 27, 2021

Want to share your point of view?

Arizona Health Care Cost Containment System is conducting a survey to determine performance and responsiveness to health care professionals contracted with UnitedHealthcare Community Plan.

Aug. 17, 2021

Time’s almost up: Link’s going away for good

In 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 exchange

Commercial | Medicaid | Medicare

Application Programming Interfaces allow electronic health care data exchange between practice management systems, including interoperability.

January 13, 2021

Avoid Claim Errors for Annual Wellness Visits

Avoid claim errors for annual wellness visits by using the correct diagnoses and codes.

Mar. 15, 2021

Avoid claim denials: Tips for Exchange plans

Exchange Plans

Avoid claim errors by ensuring you’re following Exchange plan referral requirements

Oct. 22, 2021

Arizona Medicaid: Update to fraud and abuse requirements

Medicaid

The 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 claims

Timely 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 ASIIS

Medicaid

For most vaccinations, including COVID-19, you’re required to use ASIIS.

Aug. 12, 2021

Arizona: Two accredited health equity education CME resources available on demand

Medicaid | Commercial | Medicare

OptumHealth 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 patients

Medicaid

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.

July 7, 2021

Arizona: Suspect Medicaid fraud? Learn how to report it

Our 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 pain

Medicaid

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.

July 28, 2021

Arizona: Avoid claim denials for social determinants of health

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.

Nov. 1, 2021

Arizona: Support for young adults with special needs

Medicaid

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.

Nov. 12, 2021

Coordinating care with behavioral health care professionals

Medicaid | Medicare | Exchange Plans | Commercial

Coordinating care can help ensure care for all patients, especially for those with complex conditions.

Nov. 2, 2021

UHCprovider.com behavioral health resources

Medicare | Commercial | Exchange Plans

Online resources to help PCPs screen patients for behavioral health conditions.

Oct. 22, 2021

Prepare for patients with Bind health insurance

Commercial

Add Bind to registration and claim system today.

Nov. 11, 2021

Webinar breaks down Bind personalized health plan

Commercial

Bind is offering a webinar to help health care professionals learn more about Bind and how to quickly and efficiently file claims and get the educational resources they need.

January 12, 2021

Breast Pump Coverage for GEHA Benefit Plans

See the expanded access.

Sept. 10, 2021

Ready for a busy Fall vaccination season?

Commercial | Medicaid | Exchange Plans | Medicare

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 program

Enrollment 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 flexibility

Medicaid

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.

May 12, 2021

What's new with Cancer Therapy Pathways Program

Starting May 1, 2021, the Cancer Therapy Pathways program will include follicular lymphoma and marginal zone lymphoma.

Nov. 15, 2021

Change in post-acute care management

Effective April 1, 2021, naviHealth will manage post-acute care for Medicare Advantage members in additional markets.

Oct. 27, 2021

New clinical pharmacist-led medication optimization program

Commercial

UnitedHealthcare is excited to introduce our Comprehensive Medication Management (CMM) program, a patient-centered, interactive review of current medications that may include prescription and non-prescription medications, as well as herbal supplements.

June 4, 2021

Colorado: Direct lines make prior authorizations faster, easier

New 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 Medicare

You’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 HMO

Medicare

Beginning 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 patients

Commercial

Immunochemical 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 services

Through Designated Diagnostic Provider, we can help manage costs and drive transparency by connecting patients to lab services that meet certain quality and cost-efficiency criteria.

Oct. 21, 2021

Correction: October 2021 Reimbursement Policy Update Bulletin

Medicaid

Correction to the October 2021 Reimbursement Policy Update Bulletin for the policy for Services by Unlicensed Residents and Medical Students, Professional. The Jan. 1, 2021, effective date does NOT apply to Arizona, Kansas, Mississippi, Nebraska, New Jersey, Tennessee or Texas.

July 15, 2021

Find COVID-19 vaccine availability for your state or territory

Your state’s health department has information about local COVID-19 vaccine availability.

Nov. 2, 2021

Building COVID-19 vaccine confidence

Commercial | Medicaid | Medicare

We’ve provided COVID-19 vaccine resources to review and share with your patients who may be hesitant about receiving the vaccination.

Oct. 19, 2021

Adding providers to an existing contracted group

Commercial | Medicare | Medicaid

Credentialing requirements, non-delegated providers, submitting request for participation form

January 13, 2021

New demographic update form

Updated care provider demographic information form

Sept. 13, 2021

Dialysis claims billing update

Medicare

UnitedHealthcare® Medicare Advantage will require dialysis providers to submit claims with the following modifiers. We notified you in August 2021 that effective Oct. 1, 2021, you need to use CG or KX for dialysis treatment revenue codes 821 and 881 when billing with CPT® code 90999.

Aug. 30, 2021

Dialysis claims billing update

Effective Oct. 1, 2021, in accordance with Centers for Medicare & Medicaid (CMS) guidelines, UnitedHealthcare® Medicare Advantage® will require dialysis providers to submit claims with the following modifiers.

Sept. 7, 2021

See for yourself how UnitedHealthcare solutions can help your practice

Medicaid | Medicare | Commercial

The UnitedHealthcare Digital Practice provides an on-demand resource that shows opportunities where we can help create efficiencies, which may give you more time with your patients and the members we serve.

Oct. 19, 2021

Direct deposits now managed through Optum Pay for UnitedHealthcare West Plans

Commercial

As of Feb. 2, 2021, UnitedHealthcare West health care professionals can now update and manage direct deposit (ACH) and payment information through Optum Pay.

Apr. 16, 2021

EDI claim edits coming soon

We’re giving you advance notice of EDI claim edits that will be implemented in the coming months.

Sept. 13, 2021

New EDI edits for Medicare Advantage claims

Medicare

As of Aug. 28, 2021, the new payer-level edits for Electronic Data Interchange (EDI) 837 claim submissions provide alerts of specific information that may be missing or doesn’t match data contained in our systems.

Sept. 8, 2021

Get real-time patient information in your EMR

Medicaid | Commercial

Point of Care Assist® is a virtual assistant that puts personalized, real-time patient data, including labs, prior authorization, eligibility and cost information, directly in your hands within the EMR.

Sept. 13, 2021

Enroll to get enhanced payments as an LTSS provider

Medicaid

Enroll in our ACEP program to get rate enhancement payments as a Long-Term Services and Supports (LTSS) care provider for UnitedHealthcare Community Plan members in Texas.

June 16, 2021

Get paid faster for lab claims

Speed up CLIA claims processing with Smart Edits

Sept. 15, 2021

New Florida Medicare Advantage plans in 2022

Medicare

Starting Jan.1, 2022, UnitedHealthcare is launching a new AARP® Medicare Advantage (HMO) plan and expanding existing Medicare Advantage plans into more Florida counties.

Sept. 3, 2021

Florida: In-home palliative care for UnitedHealthcare Medicare Advantage members

Medicare

Palliative care services and support at home are available for UnitedHealthcare Medicare Advantage members in Florida with a chronic or long-term illness.

Feb. 17, 2021

Florida SBIRT tools for substance abuse issues

You can play a role in identifying substance abuse risks by screening and helping patients make healthy decisions by referring them for treatment.

Oct. 22, 2021

Georgia, Virginia: Get to know Bind health insurance

Commercial

The Bind personalized health plan — backed by UnitedHealthcare — has received approval to offer fully insured benefit plans in Georgia and Virginia

July 28, 2021

Prior authorization for preimplantation genetic testing and fertility preservation

Effective July 1, 2021, preimplantation genetic testing (PGT) and fertility preservation for iatrogenic infertility are covered as standard benefits for eligible UnitedHealthcare commercial plan members.

July 2, 2021

Genetic testing for hereditary cancer: Unproven codes for RNA testing

Effective Dec. 1, 2020, 11 codes for RNA testing have been removed from the prior authorization requirement.

Nov. 10, 2021

Genetic prior authorization waiver expiring

Commercial

The penalty waiver for genetic testing prior authorizations for commercial and E & I plans expires on Dec. 31, 2021.

June 30, 2021

Genetics Prior Authorization Program update for commercial and Community plan members

UnitedHealthcare commercial plan and Community Plan is waiving administrative penalties failing to comply with the prior authorization or notification requirement for any genetic test with service date in June.

Sept. 10, 2021

Goodbye Link, hello portal

Medicaid | Medicare | Commercial | Exchange Plans

By end of year, all self-service tools will officially retire from Link and transition to the new UnitedHealthcare Provider Portal.

Dec. 1, 2021

Hawaii: Registration requirement for Medicaid providers

Medicaid

The Hawaii Department of Human Services (DHS)/Med-QUEST Division (MQD) requires all care providers who serve QUEST members to register with the new MQD provider enrollment system, HOKU.

Sept. 15, 2021

Exchange plans: Referrals no longer needed for chiropractic care

Exchange Plans

Effective Sept. 1, 2021, UnitedHealthcare Individual and Family Exchange plan members in Arizona, Maryland, North Carolina, Oklahoma, Tennessee and Washington State no longer need a referral to see a chiropractor.

June 29, 2021

Help your patients save money

Help Exchange patients avoid unnecessary cost efficiency and get the best value for their health care dollars. Refer them to a UnitedHealthcare Designated Diagnostic Provider for outpatient lab services.

June 16, 2021

Improve LGBTQ+ care with upcoming training

A free and accredited live webinar on June 29 provides insight and training on improving care for the LGBTQ+ community. PRIDE 365+ offers more advanced training.

June 30, 2021

Indiana: 90-day continuity of care policy

On April 1, 2021, we instituted a 90-day continuity of care policy for UnitedHealthcare Community Plan members in Indiana coming from another MCE or Traditional Medicaid, or newly enrolled members.

June 30, 2021

Indiana: Genetic and molecular prior authorization processes changes

The Prior Authorization & Notification tool in Link will be temporarily unavailable for online requests for genetic and molecular testing starting June 1, 2021 for Indiana Hoosier Care Connect members.

Aug. 12, 2021

Take the guesswork out of reporting with UnitedHealthcare Insights

UnitedHealthcare Insights empowers your practice with the analytics and metrics to make more informed decisions.

Apr. 30, 2021

Reminder: We’re transitioning to InterQual®, effective May 1

Helping you understand how our transition of InterQual clinical criteria may help you.

July 19, 2021

Introducing UnitedHealthcare Insights

UnitedHealthcare Insights empowers your practice with the analytics and metrics to make more informed decisions.

Oct. 22, 2021

Tennessee: Inappropriate Primary/Principle Diagnosis Policy, Facility Update

Medicaid

It was previously communicated Oct. 1, 2020, on the Community Plan Portal, that the UnitedHealthcare Community Plan is implementing a new Inappropriate Primary Diagnosis Policy, Facility, for facility claims. Implementation of this new facility policy has been delayed until on or after date of process June 1, 2021.

January 15, 2021

Kentucky Provider Orientation Webinar

As you and your staff begin providing care to new UnitedHealthcare Community Plan of Kentucky members in the Medicaid program, we want to make sure you have the information you need to do business with us. This new Medicaid program is for members currently enrolled in the state’s Medicaid, Children’s Health Insurance Program (CHIP), Aged, Blind or Disabled children and adults who are not eligible for Medicare. The program is available statewide as of Jan. 1, 2021.

June 16, 2021

Kentucky: Register to provide the COVID-19 vaccine

You can register with the Kentucky Department of Public Health to administer the COVID-19 vaccine through your practice.

June 15, 2021

Kentucky Provider Orientation Webinar

As you and your staff begin providing care to new UnitedHealthcare Community Plan of Kentucky members in the Medicaid program, we want to make sure you have the information you need to do business with us. This new Medicaid program is for members currently enrolled in the state’s Medicaid, Children’s Health Insurance Program (CHIP), Aged, Blind or Disabled children and adults who are not eligible for Medicare. The program is available statewide as of Jan. 1, 2021.

Aug. 12, 2021

Louisiana: Help Medicaid patients get cancer screenings

If UnitedHealthcare Community Plan members have missed or delayed their preventive care, we have resources to help you recommend cancer screenings.

Feb. 16, 2021

LifeBridge Nebraska Physician Coaching Program

Peer-to-peer wellness program intended to help physicians address challenges that come with their medical career.

Sept. 15, 2021

Managing information in the portal just got simpler

Commercial | Exchange Plans | Medicaid | Medicare

We simplified our security and registration process so you can easily register, add, change or deactivate users’ access to the portal.

May 24, 2021

Massachusetts: Area of Expertise (AOE) updates required

Each Massachusetts Community and State (C&S) Medicaid provider must update their Area of Expertise (AOE) by Aug. 30 for the September provider directory. Update using My Practice Profile (MPP), email or phone.

Apr. 15, 2021

Questions for us? Talk to a Provider Advocate

We invite you to attend a UnitedHealthcare WebEx informational session to learn more about our commercial and Medicare Advantage plans and policies in Colorado, Utah, Wyoming, Idaho and Montana. Ask us about HCA Healthcare, Intermountain Healthcare, OptumCare, Medicare expansion, Navigate expansion, Select Colorado and Doctors Plan.

June 30, 2021

Maryland: Asthma medication support for your practice

Maryland UnitedHealthcare Community Plan members with asthma may receive additional support for their medications. Health care professionals can receive a unique list for scheduling follow-up appointments.

May 13, 2021

Annual Maryland CAHPS results released

Medicaid

Read the CAHPS (Consumer Assessment of Health Providers and Systems) adult and child survey results.

May 13, 2021

Maryland: Help your Medicaid patients prevent diabetes

If you have Maryland Medicaid patients with prediabetes or at risk for type 2 diabetes, the HealthChoice Diabetes Prevention Program (DPP) can help.

Aug. 12, 2021

Maryland: Get payment for diabetic eye exams

Maryland: HCD International (HCDI) will support you in order to deliver high-quality care to your patients, help reduce cost, contribute to better clinical outcomes and encourage patient satisfaction.

June 14, 2021

Support for language services in Maryland

UnitedHealthcare Community Plan’s diverse members receive cultural and language support.

June 14, 2021

Maryland program for patients with complex needs

Maryland offers eligible Medicaid patients an alternative case management program for specified rare and expensive conditions.

Sept. 7, 2021

In-home palliative care for Medicare Advantage members

Medicare

Palliative care services and support at home are available for UnitedHealthcare® Medicare Advantage members in Arizona, California, Colorado, Florida, Kansas, Kentucky, Maryland, Michigan, Nebraska, New Jersey, New York, Ohio, Rhode Island, Texas, Virginia, Washington and Wisconsin.

July 9, 2021

Medicaid: Take 5 minutes to share your point of view

UnitedHealthcare Community Plan network providers will have the opportunity to share their feedback about their experience working with us by taking our Physician Satisfaction Survey. This survey applies to physicians who participate in Medicaid.

Oct. 22, 2021

Medication adherence may improve with real-time EMR-integrated solution

Commercial | Medicare | Medicaid

PreCheck MyScript® is integrated into your electronic medical record (EMR) and shows patient-specific, real-time medication costs and coverage. This valuable information is provided right at the time of prescribing, directly within your workflow in the EMR system.

June 30, 2021

Michigan: Improve the way you work with us

The UnitedHealthcare Community Plan of Michigan webpage gives you direct access to resources and information to help you work with Medicaid patients.

Aug. 12, 2021

Michigan: Resources for your sickle cell care plan

To help you treat patients with sickle cell disease, UnitedHealthcare Community Plan of Michigan has training, care managers and support resources.

Sept. 7, 2021

Required special needs plan Model of Care training

Medicare

The Centers for Medicare & Medicaid Services (CMS) requires all special needs plans (S