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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.

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.

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

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.

Oct. 1, 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.

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.

Oct. 1, 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.

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.

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.

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

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

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

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 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.

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

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.

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

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

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.

Feb. 1, 2022

Medicare new prior authorization requirement that includes clinical submission

Medicare

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

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

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.

Feb. 2, 2022

Now available: 2022 patient experience guidebook

Medicare

The 2022 patient experience guidebook is now live on UHCprovider.com.

Mar. 19, 2022

New 90-day demographic verification requirement

Commercial | Exchange Plans

Beginning 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 ready

Commercial | Medicare

This update is for commercial and Medicare plans

Apr. 1, 2022

Alabama: Home health review process changes

Medicare

Starting July 1, 2022, for UnitedHealthcare® Medicare Advantage and Dual Special Needs Plans (D-SNP) in Alabama, there will be a change in the process for requesting prior authorization for all visits after the start of care visit (SOC).

Apr. 1, 2022

Arizona: New resources available for family and professional caregivers of vulnerable individuals

Medicaid

Get 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 now

Medicaid

Updated 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 surveys

Medicaid

The Arizona Health Care Cost Containment System (AHCCCS) requires UnitedHealthcare to conduct quarterly phone surveys to help ensure the care providers in our network are complying with state appointment availability guidelines. We submit survey results to AHCCCS and the Division of Developmental Disabilities (DDD).

Mar. 17, 2022

Arizona: Clinical toolkits to support behavioral health screenings and referrals

Medicaid

Arizona Health Care Cost Containment System (AHCCCS) has developed a set of clinical toolkits to assist PCPs in assessing the needs of children/adolescents (8- 17 years old), and adults (18 years and older).

Feb. 17, 2022

Arizona Medicaid: Use the correct place of service code to avoid claim denials for telehealth services

Medicaid

To 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 syndrome

Medicaid

UnitedHealthcare 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 Guidelines

Medicaid

The 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 care

Medicaid

Learn 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 Portal

Commercial

In 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 paperless

Commercial | Medicare | Medicaid | Exchange Plans

Starting May 20, 2022, UnitedHealthcare will no longer mail prior authorization and clinical letters to network providers and facilities in AL, AR, CT, DC, DE, FL, GA, IA, IL, IN, KS, KY, LA, MA, MD, ME, MI, MO, MS, NC, ND, NE, NH, NJ, NY, OH, OK, PA, RI, SC, SD, TN, TX, VA, VT, WI and WV.

Apr. 1, 2022

California Medicaid: Access a patient list of members without a required blood screening

Medicaid

A 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 providers

Medicaid

California DHCS Policy Letter APL 21-014 and United States Preventive Services Task Force (USPSTF) guidelines require primary care providers to provide alcohol and drug Screening Assessment, Brief Interventions and Referral to Treatment services.

May 1, 2022

Understanding Care Cash

Commercial

The 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)

Commercial

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 5

Commercial | Medicare

On 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 process

Medicare

Starting 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 Dexilant

Commercial

Effective 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 update

Medicaid

Beginning Jan. 1, 2022, the following changes will be effective in Colorado, Florida, Hawaii, Indiana, Maryland, Minnesota, Nevada, New Jersey, New York CHIP, New York EPP, New York Medicaid, Pennsylvania CHIP, Rhode Island and Virginia.

Mar. 1, 2022

Act now to become a Designated Diagnostic Provider for Imaging

Commercial

Information about becoming a Designated Diagnostic Provider for Imaging. this includes the steps to becoming a Designated Diagnostic Provider as well as links to a quality questionnaire that must be completed as part of the process.

January 1, 2022

Refer your patients to a Designated Diagnostic Provider for lab services

Commercial

E & 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 experience

Medicare

Details on training modules for delivering excellent patient experience.

January 7, 2022

Virtual education sessions on new and expanded plans

Commercial | Medicare | Exchange Plans

Join 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 1

Commercial | Medicare | Medicaid

Effective June 1, 2022, in accordance with your contractual agreement that you do business with us electronically, UnitedHealthcare is no longer sending paper checks for claim payments. This change supports our continued efforts to accelerate payments to your practice by moving to digital transactions.

January 1, 2022

Exchange plans: Prior authorization updates for radiation and chemotherapy services

Exchange Plans

Starting April 1, 2022, radiation therapy and chemotherapy services will require prior authorization for Individual Exchange plans in Arizona, Alabama, Florida, Georgia, Illinois, Louisiana, Maryland, Michigan, North Carolina, Oklahoma, Tennessee, Texas, Virginia and Washington.

January 11, 2022

Payment change for Medicare Supplement member deductibles

Medicare

A new UnitedHealthcare service will pay the Medicare Supplement member’s deductible responsibility automatically to you.

Feb. 1, 2022

Free CMEs: Buprenorphine and pregnancy

Medicaid

Free 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 incentive

Medicaid

Earn an incentive when you submit an Obstetrical Risk Assessment Form (OBRAF) for UnitedHealthcare Community Plan patients.

January 1, 2022

Shared Services Updates for GEHA

Commercial

Effective Jan. 1, 2022, Government Employees Health Association (GEHA) members in certain states will access the Choice Plus provider network if enrolled in the standard option, high option or high deductible health (HDHP) plans.

January 21, 2022

Genetic prior authorization waiver has expired

Commercial

The 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 Available

Medicaid

In collaboration with the State of Hawaii Med-QUEST Division (MQD) and the Centene Institute for Advanced Health Education®, all Med-QUEST Health Plans are pleased to offer providers with a new CME-eligible training: Vaccine Hesitancy: How to Identify and Approach the “Movable Middle.”

Feb. 10, 2022

Hawaii: Vaccine hesitancy course now available

Medicaid

The Vaccine Hesitancy Training course was developed collaboratively between Ohana, AlohaCare, Kaiser, HMSA and UnitedHealthcare.

Mar. 1, 2022

Home health review process changes

Medicaid | Medicare

Starting June 1, 2022, for UnitedHealthcare Medicare Advantage and Dual Special Needs Plans, we will require initial authorization and will perform continuation of care reviews for Home Health Agencies (HHAs). This change is taking place for members enrolled in Medicare Advantage plans, including Dual Special Needs plan members, who reside and receive services in Arkansas, South Carolina, and Texas.

Feb. 1, 2022

Hospital Measures Overview

Medicare

Learn more about hospital measures with our new self-paced course Hospital Measures Overview.

Feb. 1, 2022

New online course for providers treating patients with IDD

Medicaid

A 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 access

Commercial | Medicare | Medicaid | Exchange Plans | VA CCN

Starting Feb. 2, 2022, we will no longer support the use of Internet Explorer 11 on UHCprovider.com and the UnitedHealthcare Provider Portal. For the best user experience, providers should change their browsers before then.

January 1, 2022

Indiana: New outpatient injectable drug requirements

Medicaid

Effective 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 states

Medicaid

Effective 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 update

Medicaid

Prior 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 KYMMIS

Medicaid

Medicaid benefits are suspended for UnitedHealthcare Community Plan members when they’re incarcerated. Benefits are reinstated when they’re released. However, sometimes you’ll find release dates need to be updated. We’ll work with the Department for Medicaid Services (DMS) to get eligibility updated in the KYMMIS.

Apr. 21, 2022

Kentucky Medicaid: Schedule post-discharge appointments after inpatient hospitalization to help improve health outcomes

Medicaid

For UnitedHealthcare Community Plan members who’ve been hospitalized for a mental illness, scheduling timely post-discharge appointments is vital to the member’s success after they’ve been discharged. The Follow-Up After Hospitalization for Mental Illness (FUH) HEDIS® measure assesses the percentage of inpatient discharges for a diagnosis of mental illness among patients ages 6 and older that resulted in follow-up care with a mental health provider within 7 days.

Apr. 14, 2022

Louisiana Medicaid: Breast milk storage bags are now covered as durable medical equipment

Medicaid

Effective Feb. 1, 2022, breast milk storage bags are covered as durable medical equipment for lactating UnitedHealthcare Community Plan members. Coverage is retroactive. You don’t need to take any action. We’ll reprocess impacted claims when our system is updated.

Apr. 21, 2022

New enrollment requirement for Louisiana Medicaid

Medicaid

All 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 Plans

Medicaid

Effective 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 Health

Medicaid

The 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 surgery

Medicaid

The 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 Health

Medicaid

Effective June 16, 2022, universal drug testing/screening in a primary care setting will no longer be covered. Drug testing without signs or symptoms of substance use, or without current controlled substance treatment, will not be covered. Please be aware of this policy change when treating UnitedHealthcare Community Plan members and filing claims.

Apr. 5, 2022

Louisiana Department of Health COVID-19 temporary measures

Medicaid

Summary 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 response

Medicaid

To 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 members

Medicaid

Starting 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 soon

Medicaid

UnitedHealthcare Community Plan of Maryland works with health care professionals to complete medical record reviews required by the Maryland Department of Health (MDH). If you’re selected for an audit, we’ll look at your 2021 medical records to help make sure you’re meeting MDH Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements.

January 14, 2022

Medicaid: New therapy prior authorization requirements in Maryland

Medicaid

Prior 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 codes

Medicare

Beginning 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 services

Medicaid

The Centers for Medicare & Medicaid (CMS) requires all Medicare members, including Dual Eligible Special Needs Plan (D-SNP) members, to know costs prior to receiving non-covered services. Request a prior authorization if you know or have reason to believe that a service for a Medicare Advantage member may not be covered.

Feb. 17, 2022

New Medicare Advantage prior authorization requirement resources available

Medicare

A new FAQ is posted to provide additional information about UnitedHealthcare® Medicare plan submission requirements. These requirements affect physical therapy (PT), occupational therapy (OT) and speech therapy (ST) services in Arizona, Georgia, New Jersey and South Carolina.

May 19, 2022

UnitedHealthcare Community Plan: What to expect during a site visit

Medicaid

Health 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 2022

Commercial | Medicare | Medicaid | Exchange Plans

Effective Feb. 4, provider remittance advice (PRAs) for medical claims to network health care professionals and facilities (primary and ancillary) in the Southeast, Central and Northeast regions will go paperless. This is a change from previous dates.

January 10, 2022

New 2022 Medicare benefit

Medicare

A 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 C

Medicaid

The Michigan Department of Health and Human Services (MDHHS) launched the We Treat Hep C Initiative to help eliminate the hepatitis C virus (HCV) in Michigan. The We Treat Hep C initiative has removed barriers to care and offers support to health care professionals testing and treating UnitedHealthcare Community Plan members for hepatitis C.

Apr. 1, 2022

Minnesota Medicaid: Injectable chemotherapy prior authorization update

Medicaid

Effective May 1, 2022, UnitedHealthcare will expand the existing prior authorization requirement for injectable chemotherapy drugs received in an outpatient setting to include the UnitedHealthcare Community Plan of Minnesota.

May 1, 2022

Minnesota Medicaid: New prior authorization requirement for cognitive rehabilitation

Medicaid

Effective June 1, 2022, prior authorization will be required for cognitive rehabilitation services (procedure code H2012 HK) for UnitedHealthcare Community Plan members enrolled in Families & Children and MNCare plans. This requirement applies to members whose ID cards list the group number MNHCP.

May 1, 2022

Missouri: Health Homes training now available

Medicaid

Health homes are community-based organizations contracted with either MO HealthNet or Missouri Department of Mental Health to provide physical or behavioral health care management services to Medicaid members who meet the Centers for Medicare and Medicaid Services (CMS) criteria. Training is available today.

Apr. 1, 2022

Medical Policy Update Bulletins: April 2022

Commercial | Medicare | Medicaid | Exchange Plans

Medical policy updates for April 2022 for the following plans: Medicare, Medicaid, Exchanges, and Commercial.

Feb. 1, 2022

Medical Policy Update Bulletins: February 2022

Commercial | Medicare | Medicaid | Exchange Plans

Medical policy updates for February 2022 for the following plans: Medicare, Medicaid, Exchanges, and Commercial.

January 1, 2022

Medical Policy Update Bulletins: January 2022

Commercial | Medicare | Medicaid | Exchange Plans

Medical policy updates for January 2022 for the following plans: Medicare, Medicaid, Exchanges, and commercial.

Mar. 1, 2022

Medical Policy Update Bulletins: March 2022

Commercial | Medicare | Medicaid | Exchange Plans

Medical policy updates for March 2022 for the following plans: Medicare, Medicaid, Exchanges, and Commercial.

May 1, 2022

Medical Policy Update Bulletins: May 2022

Commercial | Medicare | Medicaid | Exchange Plans

Medical policy updates for May 2022 for the following plans: Medicare, Medicaid, Exchanges, and Commercial.

Feb. 1, 2022

Change in post-acute care management

Medicare

Starting 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 claims

Medicaid

As 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 Edits

Medicaid

Effective Jan. 28, 2022, you’re required to electronically attach sterilization consent forms and child medical evaluation forms when submitting claims. There are special steps you need to take. Here’s how to do it.

Apr. 20, 2022

Nebraska Medicaid: Temporary per diem rate increase for nursing and assisted living facilities

Medicaid

Nebraska 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 use

Medicaid

UnitedHealthcare 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 testing

Medicaid

Effective 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 claims

Medicaid

Effective 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 claims

Medicaid

Effective 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)

Medicaid

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 1

Medicaid

Effective 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 drugs

Medicaid

Effective 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, 2022

Medicaid

Effective 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 time

Medicaid

In 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 CAQH

Commercial

Commercial health care professionals contracted with the Empire Plan in New York can now use CAQH to verify, update and attest to their demographic data. They can also attest using MPP, mail or fax. This is now required every 90 days.

Apr. 21, 2022

New York Medicaid: Updated MAT formulary effective as of March 22, 2022

Medicaid

As 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. 1

Medicaid | Medicare

Effective 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 care

Medicaid

You were notified in January 2021 that effective July 1, 2021, Voluntary Foster Care Agencies (VFCAs) would no longer be the payor for services of children or youth in foster care. These patients were transitioned to a New York Medicaid managed care plan.

Feb. 17, 2022

New York Medicaid: Providers may be responsible for coordinating services for foster care

Medicaid

UnitedHealthcare 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 incentive

Medicaid

Network 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 anesthesiologists

Commercial

Participating 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 palonosetron

Medicaid

Prior 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 treatments

Medicaid

As referenced in the New York State Medicaid Update - September 2021 Volume 37 - Number 11, New York State (NYS) Medicaid does not cover prescription or physician-administered drugs used for the treatment of sexual dysfunction (SD) or erectile dysfunction (ED).

Feb. 10, 2022

Observation notifications are no longer required for most plans

Commercial | Medicare

As 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 patients

Medicaid

Introducing 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 members

Commercial

Medication sourcing requirements removed for 5 oncology-supportive drugs for commercial plan members.

Apr. 1, 2022

New outpatient procedure grouper mapping exhibits for 2022

Medicaid

Effective 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 update

Commercial

Our updated 2021 UnitedHealthcare Outpatient Procedure Grouper (OPG) Exhibit is available at UHCprovider.com/claims.

January 1, 2022

New phone number for OrthoNet Oxford

Commercial

Starting Jan. 1, 2022, the current OrthoNet Oxford Call Center toll-free number, 888-381-3152, will be deactivated. Oxford providers should instead call the standard Oxford Provider Call Center at 800-666-1353.

Feb. 1, 2022

Updates for Oxford policies, prior authorizations and claims

Commercial

UnitedHealthcare 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 July

Commercial | Medicare

Beginning 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, 2022

Commercial

UnitedHealthcare Oxford will have a specialty pharmacy requirement effective May 1, 2022.

May 16, 2022

Pennsylvania Medicaid: Billing updates for personal care services

Medicaid

The Pennsylvania Department of Human Services has updated its billing requirements for personal care services that are verified using an electronic visit verification (EVV) system. For dates of service starting May 1, 2022, health care professionals administering personal care services to UnitedHealthcare Community Plan members in their home must use HCPCS code T1019 when submitting claims and requesting prior authorization.

Mar. 17, 2022

New enhancements make prior authorization and notifications easier

Commercial | Medicare | Medicaid

Two new features, have been added to the Prior Authorization tool in the UnitedHealthcare Provider Portal. Now submit a prior authorization cancellation request in the UnitedHealthcare Provider Portal with Cancel Case. Requests are also automatically saved with Save as Draft.

Mar. 17, 2022

Patient self-scheduling via DocASAP launching March 31, 2022

Medicare | Commercial | Medicaid

Starting 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 accuracy

Medicaid | Commercial | Medicare

Announcing 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 Network

Commercial

Applications for the 2022 UnitedHealthcare Preferred Lab Network are now open.

Apr. 1, 2022

April 2022 policy and protocol updates overview

Commercial | Medicare | Medicaid | Exchange Plans

Review the latest UnitedHealthcare prior authorization, medical policy, pharmacy, reimbursement, laboratory and policy and protocol updates.

Feb. 1, 2022

February 2022 policy and protocol updates overview

Commercial | Medicare | Medicaid | Exchange Plans

Review the latest UnitedHealthcare prior authorization, medical policy, pharmacy, reimbursement, laboratory and policy and protocol updates.

January 1, 2022

January 2022 policy and protocol updates overview

Commercial | Medicare | Medicaid | Exchange Plans

Review the latest UnitedHealthcare prior authorization, medical policy, pharmacy, reimbursement, laboratory and policy and protocol updates.

Mar. 1, 2022

March 2022 policy and protocol updates overview

Commercial | Medicare | Medicaid | Exchange Plans

Review the latest UnitedHealthcare prior authorization, medical policy, pharmacy, reimbursement, laboratory and policy and protocol updates.

May 1, 2022

May 2022 policy and protocol updates overview

Commercial | Medicare | Medicaid | Exchange Plans

Review 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 easier

Medicaid | Commercial | Medicare

Make 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 ultrasounds

Commercial

Prenatal 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 ultrasounds

Commercial

Starting 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 1

Commercial | Medicaid | Exchange Plans

Effective June 1, 2022, procedure codes will be updated for the radiology notification and prior authorization and cardiology prior authorization programs for UnitedHealthcare Community Plan, Commercial and Exchange.

Mar. 1, 2022

New radiation therapy prior authorization requirements

Medicare | Medicaid

Prior authorization will be required for some outpatient radiation therapies.

Apr. 21, 2022

Training available: Therapeutic Radiation Prior Authorization program

Medicare

Training 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 enrollees

Medicaid | Commercial

In compliance with the Health and Human Services (HHS) - Risk Adjustment Data Validation (RADV) program, we are required to provide supporting medical documentation to enable the audit of medical encounter(s) for UnitedHealthcare members.

Apr. 1, 2022

Reimbursement Policy Update Bulletins: April 2022

Commercial | Medicare | Medicaid | Exchange Plans

You 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 2022

Commercial | Medicare | Medicaid | Exchange Plans

You 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 2022

Commercial | Medicare | Medicaid | Exchange Plans

You 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 2022

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.

May 1, 2022

Reimbursement Policy Update Bulletins: May 2022

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.

Apr. 1, 2022

Specialty Medical Injectable Drug Program updates: April 2022

Commercial | Medicare | Medicaid | Exchange Plans

Specialty 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 2022

Commercial | Medicare | Medicaid | Exchange Plans

Specialty 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 2022

Commercial | Medicare | Medicaid | Exchange Plans

Specialty 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 2022

Commercial | Medicare | Medicaid | Exchange Plans

Specialty 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 2022

Commercial | Medicare | Medicaid | Exchange Plans

Specialty 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 DocASAP

Medicare

Starting January 2022, primary care providers in Texas, Virginia and Wisconsin, currently connected to the DocASAP scheduling platform will have self-scheduling enabled in the UnitedHealthcare Medicare Member Portal. Included in the first phase of this pilot are Medicare Advantage (MA), Medicare Advantage Prescription Drug (MAPD), Sponsored Supplemental Plan (SSP), Dual Special Needs Plan (D-SNP), Chronic Special Needs Plan (C-SNP) and Institutional Special Needs Plan (I-SNP) members.

Apr. 1, 2022

Action required: 10-minute Model of Care training

Medicaid

The Centers for Medicare & Medicaid Services (CMS) requires all special needs plans (SNPs) to provide initial and annual Model of Care (MOC) training to network providers contracted to see SNP members and out-of-network providers who routinely see SNP members.

Apr. 1, 2022

Specialty Pharmacy Requirement updates for certain medical benefit medications

Commercial

The 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 screenings

Medicaid

The early and periodic screening, diagnostic and treatment (EPSDT) screening benefit of UnitedHealthcare Community plan helps provide comprehensive and preventative health care services for children from birth through age 20.

May 4, 2022

Tennessee Medicaid: Save time and help your patients access specialty care

Medicaid

UnitedHealthcare Community Plan network care providers in Tennessee have access to AristaMD, a service that can help make specialty care appointments for members. This service can help save your staff time and help your patients get the specialty care they need.

Apr. 1, 2022

Tennessee: Review the latest criteria for reportable events

Medicaid

As of Jan. 1, 2022, all TennCare CHOICES in Long Term Services (CHOICES) and Employment and Community First (ECF) providers must use the reportable event management (REM) process developed by the Department of Developmental Disabilities (DIDD) and TennCare.

May 19, 2022

Texas: Changes to CHIP copayments for Mental Health and Substance Use Disorder Services

Medicaid

Effective 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 claims

Medicaid

Effective 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 requirement

Medicaid

The 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, 2022

Medicaid

Texas 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 2022

Medicaid

Effective May 1, 2022, prior authorization is required when prescribing certain drugs for UnitedHealthcare Community Plan of Texas members to treat neuromyelitis optica spectrum disorder, eczema and migraines.

Feb. 22, 2022

Claims process change for Texas STAR Kids (Medicaid) members with Medicare benefits

Medicare | Medicaid

Effective April 1, 2022, bill claims for Star Kid (Medicaid) members with Medicare benefits to Medicare first. Then, unless the service is exempted, bill the Texas Medicaid & Healthcare Partnership (TMHP) for secondary payment to avoid denials.

January 1, 2022

Medicaid: New prior authorization codes in select states

Medicaid

Update 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 directory

Medicaid | Commercial | Medicare | Exchange Plans

A recent review has shown that some phone numbers in our network directory are incorrect. Accurate directory information helps ensure members can find care. Please review, update and attest that all practice phone numbers, and other demographics, are correct.

May 19, 2022

Virginia: New programs to promote patient health and wellness

Medicaid

New 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 providers

Medicaid

To 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 maintenance

Medicaid

The Virginia Medicaid agency will launch a new technology platform in April 2022. Providers credentialed in 1 or more managed care organizations will use the new Provider Services Solution (PRSS) to complete enrollment and maintenance processes. This change is part of the Medicaid Enterprise System (MES) project.

Apr. 1, 2022

Veteran’s Affairs Community Care Network home health updates

VA CCN

The Centers for Medicare & Medicaid Services (CMS) recently announced changes to claim processing requirements that affect using Requests for Anticipated Payments (RAPs) for home health care claims, including changes to submission timelines and late penalties.

January 1, 2022

New coverage determinations for Vitamin D testing

Medicaid

For claims processed on or after March 1, 2022, vitamin D screening CPT codes 82306, 82652 or 0038U will only be covered for UnitedHealthcare commercial members diagnosed with one of the listed diagnosis codes in the medical policy.

Feb. 1, 2022

Help improve behavioral health outcomes for your patients

Medicaid

For 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 professionals

Medicaid

You 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 paperless

Commercial | Medicare | Medicaid | Exchange Plans

Starting April 1, 2022, UnitedHealthcare will no longer mail prior authorization and clinical letters to network providers and facilities in: Alaska, Arizona , California, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Washington and Wyoming.

Mar. 17, 2022

Wisconsin: Interim payment for long length of stay

Medicaid

Members 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 requirement

Medicare

UnitedHealthcare 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 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.

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).

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.

January 13, 2022

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.

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.

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.

May 19, 2022

New clinical pharmacist-led medication optimization program

Medicare | Medicaid

This pharmacist-led program evaluates medication therapy for indication, effectiveness, safety and the patient’s ability to take their medications as prescribed. We use data obtained through pharmacy claims, medical claims and self-reporting.

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.