Effective April 1, 2021, you’ll be required to submit a prior authorization if you plan to bill for Synagis and Xolair on the medical benefit for a UnitedHealthcare Community Plan member in California or New York.
Effective April 1, 2021, prior authorization will be required for certain stereotactic body radiation therapy and stereotactic radiosurgery services for Exchange plan members in Arizona, Maryland, North Carolina, Oklahoma, Tennessee, Virginia and Washington.
If you’re used to forwarding the Network Bulletin on to your staff members, save yourself a step and subscribe your whole team. They can receive their own personalized Network Bulletin email, helping your practice to save time, receive important information faster and help relieve administrative burden.
In a September 2020 Network Bulletin article -- New York Payment Policy Change -- we incorrectly said CPT® code revisions to the New York Non-Covered Code Payment Policy applied to UnitedHealthcare Community Plan Essential Plan (EP).
The March Network Bulletin includes updates for medical and reimbursement policy updates, along with updates on prior authorization for Radiology, Cardiology, Radiation Therapy and facet Injections. There are also updates on home health, electronic payments, site of service review and more.
Starting with dates of service on June 7, 2021, outpatient hospitals must obtain certain oncology supportive care medications from the participating specialty pharmacies we indicate, except as otherwise authorized by us.
The May Network Bulletin includes updates for medical and reimbursement policy updates. Along with genetic and molecular testing prior authorization, antiemetics prior authorization, outpatient procedure grouper annual update and more.
Sourcing requirement for outpatient hospitals to obtain certain oncology supportive care medications for UnitedHealthcare commercial plan members will go into effect on June 18, 2021, not June 7, 2021 as previously announced in March and April 2021
Effective Oct. 1, 2021, your post-acute care workflow will change for UnitedHealthcare® Medicare Advantage members in Arkansas, Delaware, Hawaii, Idaho, Louisiana, Mississippi, Montana, Nevada, Pennsylvania, Utah, West Virginia and Wyoming.
Starting Nov. 1, 2021, 6 prior authorization codes for facet injections (64490–64495) will be added to UnitedHealthcare Community (Medicaid) Plans in Arizona, California, Maryland, Mississippi, Missouri, New Jersey and Wisconsin.
The policy and protocol updates for August 2021 include prior authorization changes for cardiovascular and commercial plan codes. You can also review the changes to medical PRAs, post-acute care management and more.
We’re adding codes to the prior authorization list for UnitedHealthcare commercial plans (to include All Savers, River Valley, Neighborhood Health Partnership, UnitedHealthcare West, MidAtlantic Health Plans).
The policy and protocol updates for September 2021 include prior authorization changes for radiology, self-administered drug claims . You can also review the changes to medical PRAs, post-acute care management and more.
Effective Dec. 1, 2021, we will reimburse maternal services for Medicaid members to hospitals that align with the level-of-care designations assigned by the Texas Health and Human Services Commission (HHSC).
On Jan. 1, 2022, UnitedHealthcare will launch Individual and Family plans on the exchange in 7 new states. Learn about plan requirements, including prior authorization, referrals, site of service medical necessity reviews and more.
For dates of service on or after Jan. 1, 2022, for UnitedHealthcare commercial plans, we’re expanding our prior authorization requirements to include certain surgical, screening colonoscopy, office and MRI/CT imaging procedures in Kentucky.
The policy and protocol updates for October 2021 include prior authorization changes for anti-emetics and genetric and molecular testing. You can also review the changes to speciality pharmacy requirements and updates for 2022.
Starting Nov. 17, 2021, UnitedHealthcare Community Plan of New Jersey is implementing a referral process for members who need specialty care. This will require primary care providers (PCPs) to generate a referral for members to see in-network specialists.
Effective Nov. 1, 2021, you’re required to submit a prior authorization for certain drugs used to treat multiple sclerosis (MS) or high phosphate levels in Texas UnitedHealthcare Community Plan members.
CPT® codes 62292, 64454, 64480, 64491, 64492, 64494, 64496, 64634 and 64636, listed under pain management and injections, will not be subject to prior authorization requirements on Nov. 1, 2021, for UnitedHealthcare commercial plans including All Savers, River Valley, Neighborhood Health Partnership, UnitedHealthcare West and MidAtlantic Health Plans.
Starting Dec. 1, 2021, we’ll not require prior authorization and notification for electrophysiology implant procedures subject to the UnitedHealthcare outpatient cardiology notification/prior authorization protocol when performed and appropriately billed as an inpatient service for UnitedHealthcare Community Plan, Medicare, commercial and Exchange plan members.
UnitedHealthcare Medicare plan prior authorization changes for PT, OT and ST services at multi-disciplinary offices and outpatient hospital settings for Arkansas, Georgia, New Jersey and South Carolina.
Heritage Health Adult (HHA) has expanded Medicaid coverage to patients, ages 19–64, whose income is at or below 138% of the federal poverty level. All HHA members are now eligible for benefits under a single package.
The policy and protocol updates for November 2021 include prior authorization changes for site of service reviews, clinical submission requirements, private duty nursing and cardiac event monitoring. You can also review the changes to appeal decision letters and paperless PRAs along with updated pharmacy and prescription drugs lists.
Starting Feb. 1, 2022, we’re updating the prior authorization requirements and site of service medical necessity reviews for certain surgical procedures. These updates apply to UnitedHealthcare commercial and Individual Exchange plans.
Starting Feb. 1, 2022, we’ll require prior authorization for HCPCS code T1000. This code covers private duty nursing, which is a complimentary benefit offered to designated Medicare Advantage retiree plans through UnitedHealthcare Retiree Solutions.
UnitedHealthcare follows all CAA, government-mandated price transparency and disclosure regulations regarding our agreements with health care professionals, medical groups, facilities and ancillary providers.
Starting Dec. 1, 2021, UnitedHealthcare Individual Exchange plans will not require prior authorization for outpatient therapy services (physical, occupational and speech therapy), up to the member’s benefit limit.
We previously announced a Jan. 1, 2022, implementation date for prior authorization and site of service reviews for certain procedures, for commercial plans in Massachusetts. We’re delaying this implementation until further notice.
Effective Nov. 1, 2021, you’re required to submit a prior authorization for certain drugs used to treat multiple sclerosis (MS) or high phosphate levels in Texas UnitedHealthcare Community Plan members.
Starting July 1, 2022, for UnitedHealthcare® Medicare Advantage and Dual
Special Needs Plans (D-SNP) in Alabama, there will be a change in the process
for requesting prior authorization for all visits after the start of care visit (SOC).
The Arizona Health Care Cost Containment System (AHCCCS) requires UnitedHealthcare to conduct quarterly phone surveys to help ensure the care providers in our network are complying with state appointment availability guidelines. We submit survey results to AHCCCS and the Division of Developmental Disabilities (DDD).
Arizona Health Care Cost Containment System (AHCCCS) has developed a set of
clinical toolkits to assist PCPs in assessing the needs of children/adolescents (8-
17 years old), and adults (18 years and older).
Health care professionals in Arizona should refer patients to LabCorp for services. In Arizona LabCorp is the only in-network provider for: Arizona Health Care Cost Containment System (AHCCCS), Complete Care (ACC), Developmental Disabilities (DD), Arizona Long-Term Care Elderly Physical Disabilities (ALTCS EPD) and Medicare Dual Special Needs Plan (D-SNP) members.
Starting June 3, 2022, UnitedHealthcare will no longer mail prior authorization and clinical letters to network providers and facilities in AL, AR, CT, DC, DE, FL, GA, IA, IL, IN, KS, KY, LA, MA, MD, ME, MI, MO, MS, NC, ND, NE, NH, NJ, NY, OH, OK, PA, RI, SC, SD, TN, TX, VA, VT, WI and WV.
California DHCS Policy Letter APL 21-014 and United States Preventive Services
Task Force (USPSTF) guidelines require primary care providers to provide alcohol
and drug Screening Assessment, Brief Interventions and Referral to Treatment
Beginning Jan. 1, 2022, the following changes will be effective in Colorado, Florida, Hawaii, Indiana, Maryland, Minnesota, Nevada, New Jersey, New York CHIP, New York EPP, New York Medicaid, Pennsylvania CHIP, Rhode Island and Virginia.
Information about becoming a Designated Diagnostic Provider for Imaging. this includes the steps to becoming a Designated Diagnostic Provider as well as links to a quality questionnaire that must be completed as part of the process.
Effective June 1, 2022, in accordance with your contractual agreement that you do business with us electronically, UnitedHealthcare is no longer sending paper checks for claim payments. This change supports our continued efforts to accelerate payments to your practice by moving to digital transactions.
Starting April 1, 2022, radiation therapy and chemotherapy services will require prior authorization for Individual Exchange plans in Arizona, Alabama, Florida, Georgia, Illinois, Louisiana, Maryland, Michigan, North Carolina, Oklahoma, Tennessee, Texas, Virginia and Washington.
Beginning July 1, 2022, all claims submissions and inquiries that were being sent to Tufts Health Freedom Plan should now be directed to UnitedHealthcare. You can learn more about Claims, Billings and Payments on UHCprovider.com. This is for Connecticut, Massachussets, Maine, New Hampshire and Vermont Freedom Health Plans.
Effective Jan. 1, 2022, Government Employees Health Association (GEHA) members in certain states will access the Choice Plus provider network if enrolled in the standard option, high option or high deductible health (HDHP) plans.
In collaboration with the State of Hawaii Med-QUEST Division (MQD) and the
Centene Institute for Advanced Health Education®, all Med-QUEST Health Plans
are pleased to offer providers with a new CME-eligible training: Vaccine Hesitancy:
How to Identify and Approach the “Movable Middle.”
Starting June 1, 2022, for UnitedHealthcare Medicare Advantage and Dual Special Needs Plans, we will require initial authorization and will perform continuation of care reviews for Home Health Agencies (HHAs). This change is taking place for members enrolled in Medicare Advantage plans, including Dual Special Needs plan members, who reside and receive services in Arkansas, South Carolina, and Texas.
Starting Feb. 2, 2022, we will no longer support the use of Internet Explorer 11 on UHCprovider.com and the UnitedHealthcare Provider Portal. For the best user experience, providers should change their browsers before then.
Effective for dates of service on or after November 2, 2021, the Indiana Health Coverage Programs (IHCP) will reimburse providers for providing COVID-19 vaccine information and/or education to members.
Medicaid benefits are suspended for UnitedHealthcare Community Plan members when they’re incarcerated. Benefits are reinstated when they’re released. However, sometimes you’ll find release dates need to be updated. We’ll work with the Department for Medicaid Services (DMS) to get eligibility updated in the KYMMIS.
For UnitedHealthcare Community Plan members who’ve been hospitalized for a mental illness, scheduling timely post-discharge appointments is vital to the member’s success after they’ve been discharged. The Follow-Up After Hospitalization for Mental Illness (FUH) HEDIS® measure assesses the percentage of inpatient discharges for a diagnosis of mental illness among patients ages 6 and older that resulted in follow-up care with a mental health provider within 7 days.
Effective Feb. 1, 2022, breast milk storage bags are covered as durable medical equipment for lactating UnitedHealthcare Community Plan members. Coverage is retroactive. You don’t need to take any action. We’ll reprocess impacted claims when our system is updated.
The Louisiana Department of Health revised the Informational Bulletin 22-4 regarding the Medicaid Provider Enrollment Portal lookup tool on June 10, 2022. The Medicaid Provider Enrollment Portal is now available at LAmedicaid.com. When using the lookup tool, you may search by NPI, provider name, provider type, specialty, address, city and state, or zip code.
Effective June 16, 2022, universal drug testing/screening in a primary care setting will no longer be covered. Drug testing without signs or symptoms of substance use, or without current controlled substance treatment, will not be covered. Please be aware of this policy change when treating UnitedHealthcare Community Plan members and filing claims.
UnitedHealthcare Community Plan of Maryland works with health care professionals to complete medical record reviews required by the Maryland Department of Health (MDH). If you’re selected for an audit, we’ll look at your 2021 medical records to help make sure you’re meeting MDH Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements.
The Centers for Medicare & Medicaid (CMS) requires all Medicare members, including Dual Eligible Special Needs Plan (D-SNP) members, to know costs prior to receiving non-covered services. Request a prior authorization if you know or have reason to believe that a service for a Medicare Advantage member may not be covered.
A new FAQ is posted to provide additional information about UnitedHealthcare® Medicare plan submission requirements. These requirements affect physical therapy (PT), occupational therapy (OT) and speech therapy (ST) services in Arizona, Georgia, New Jersey and South Carolina.
Effective Sept. 9, 2022, Medicaid (C&S) PRAs in Effective Sept. 9, 2022, Medicaid (C&S) PRAs in KY, MO, OH and DC are going paperless. View in the portal (Document Library), with Optum Pay or through EDI.
Effective Feb. 4, provider remittance advice (PRAs) for medical claims to network health care professionals and facilities (primary and ancillary) in the Southeast, Central and Northeast regions will go paperless. This is a change from previous dates.
The Michigan Department of Health and Human Services (MDHHS) launched the We Treat Hep C Initiative to help eliminate the hepatitis C virus (HCV) in Michigan. The We Treat Hep C initiative has removed barriers to care and offers support to health care professionals testing and treating UnitedHealthcare Community Plan members for hepatitis C.
Effective May 1, 2022, UnitedHealthcare will expand the existing prior
authorization requirement for injectable chemotherapy drugs received in an
outpatient setting to include the UnitedHealthcare Community Plan of Minnesota.
Effective June 1, 2022, prior authorization will be required for cognitive rehabilitation services (procedure code H2012 HK) for UnitedHealthcare Community Plan members enrolled in Families & Children and MNCare plans. This requirement applies to members whose ID cards list the group number MNHCP.
Effective Aug. 1, 2022, providers in Missouri are required to submit claims with the Current Procedural Terminology (CPT) codes for obstetrical service provided to Medicaid plan members. Claims without the proper codes will be denied.
Health homes are community-based organizations contracted with either MO HealthNet or Missouri Department of Mental Health to provide physical or behavioral health care management services to Medicaid members who meet the Centers for Medicare and Medicaid Services (CMS) criteria. Training is available today.
Effective Jan. 28, 2022, you’re required to electronically attach sterilization consent forms and child medical evaluation forms when submitting claims. There are special steps you need to take. Here’s how to do it.
Effective Aug. 1, 2022, you’ll see new codes on the prior authorization list for cardiovascular, prostate, and spinal surgery procedures. These changes impact UnitedHealthcare Community Plan of New Jersey’s Medicaid and Long-Term Care plans.
Commercial health care professionals contracted with the Empire Plan in New York can now use CAQH to verify, update and attest to their demographic data. They can also attest using MPP, mail or fax. This is now required every 90 days.
You were notified in January 2021 that effective July 1, 2021, Voluntary Foster Care Agencies (VFCAs) would no longer be the payor for services of children or youth in foster care. These patients were transitioned to a New York Medicaid managed care plan.
As referenced in the New York State Medicaid Update - September 2021 Volume
37 - Number 11, New York State (NYS) Medicaid does not cover prescription or
physician-administered drugs used for the treatment of sexual dysfunction (SD) or
erectile dysfunction (ED).
Starting Jan. 1, 2022, the current OrthoNet Oxford Call Center toll-free number, 888-381-3152, will be deactivated. Oxford providers should instead call the standard Oxford Provider Call Center at 800-666-1353.
The Pennsylvania Department of Human Services has updated its billing requirements for personal care services that are verified using an electronic visit verification (EVV) system. For dates of service starting May 1, 2022, health care professionals administering personal care services to UnitedHealthcare Community Plan members in their home must use HCPCS code T1019 when submitting claims and requesting prior authorization.
Two new features, have been added to the Prior Authorization tool in the UnitedHealthcare Provider Portal. Now submit a prior authorization cancellation request in the UnitedHealthcare Provider Portal with Cancel Case. Requests are also automatically saved with Save as Draft.
Facilities contracted with UnitedHealthcare and providing post-acute inpatient services for UnitedHealthcare® Medicare Advantage members are required to obtain prior authorization before members can be admitted to a post-acute care facility.
Effective June 1, 2022, procedure codes will be updated for the radiology
notification and prior authorization and cardiology prior authorization programs for
UnitedHealthcare Community Plan, Commercial and Exchange.
In compliance with the Health and Human Services (HHS) - Risk Adjustment Data Validation (RADV) program, we are required to provide supporting medical documentation to enable the audit of medical encounter(s) for UnitedHealthcare members.
Starting January 2022, primary care providers in Texas, Virginia and Wisconsin, currently connected to the DocASAP scheduling platform will have self-scheduling enabled in the UnitedHealthcare Medicare Member Portal. Included in the first phase of this pilot are Medicare Advantage (MA), Medicare Advantage Prescription Drug (MAPD), Sponsored Supplemental Plan (SSP), Dual Special Needs Plan (D-SNP), Chronic Special Needs Plan (C-SNP) and Institutional Special Needs Plan (I-SNP) members.
The Centers for Medicare & Medicaid Services (CMS) requires all special needs plans (SNPs) to provide initial and annual Model of Care (MOC) training to network providers contracted to see SNP members and out-of-network providers who routinely see SNP members.
The early and periodic screening, diagnostic and treatment (EPSDT) screening benefit of UnitedHealthcare Community plan helps provide comprehensive and preventative health care services for children from birth through age 20.
TennCare has advised that the sterilization consent form is codified in regulation at 42 CFR §441.258 and §441.259 should continue to be used regardless of whether there is a current Office of Management and Budget (OMB) date.
UnitedHealthcare Community Plan network care providers in Tennessee have access to AristaMD, a service that can help make specialty care appointments for members. This service can help save your staff time and help your patients get the specialty care they need.
As of Jan. 1, 2022, all TennCare CHOICES in Long Term Services (CHOICES) and Employment and Community First (ECF) providers must use the reportable event management (REM) process developed by the Department of Developmental Disabilities (DIDD) and TennCare.
Effective May 1, 2022, prior authorization is required when prescribing certain drugs for UnitedHealthcare Community Plan of Texas members to treat neuromyelitis optica spectrum disorder, eczema and migraines.
Effective April 1, 2022, bill claims for Star Kid (Medicaid) members with Medicare benefits to Medicare first. Then, unless the service is exempted, bill the Texas Medicaid & Healthcare Partnership (TMHP) for secondary payment to avoid denials.
A recent review has shown that some phone numbers in our network directory are incorrect. Accurate directory information helps ensure members can find care. Please review, update and attest that all practice phone numbers, and other demographics, are correct.