November monthly overview

Network News is published twice a month. See updates below.

November 1 publication

Medical policy updates
Medical policy updates for November 2024 for the following plans: Medicare, Medicaid, Exchanges and commercial.

Reimbursement policy updates
See the latest updates for reimbursement policies.

Specialty Medical Injectable Drug program updates
See the latest updates to requirements for Specialty Medical Injectable Drugs for UnitedHealthcare members.

Pharmacy and clinical updates
Access upcoming new or revised clinical programs and implementation dates for UnitedHealthcare plans.

Massachusetts: Expedited credentialing for care providers of closed hospitals
UnitedHealthcare Community Plan of Massachusetts offers expedited credentialing for providers from 2 closed hospitals.

Earn incentives as a Patient Centered Medical Home
PCMH certified practices in Michigan can earn monthly incentives for UnitedHealthcare Community Plan members.

New Jersey Medicaid: Unbundle maternity codes to avoid claim denials
Global billing isn’t permitted in New Jersey for maternity care services. See how to avoid claim denials.

Change to UnitedHealthcare Community Plan of New York non-covered codes list
Starting Nov. 1, 2024, UnitedHealthcare Community Plan will add CPT code 82652 to its list of non-covered Medicaid codes.

Changes to genetic and molecular testing coverage and prior authorization requirements
Certain CPT codes associated with pharmacogenetic testing will no longer be covered or require prior authorization.

New online utilization management requirement
You will be required to submit utilization management requests online for patients delegated to Optum Health Networks.

Verify address to avoid APWUHP claim appeal delays
Claim appeals addressed incorrectly may be delayed or go unanswered. And APWUHP members to be assigned a new group number.

Streamline eligibility and billing with enhanced coordination of benefits information
Coordination of benefits now available through API and the UnitedHealthcare Provider Portal.

Now, more Surest support at your fingertips
We’re excited to share new ways to get the answers you need for Surest™ health plans, including chat and phone support.

Jan. 1, 2025, updates to Individual Exchange plans PDLs
Effective Jan. 1, 2025, we’re making changes to the prescription drug lists (PDLs) for UnitedHealthcare Individual Exchange plans.

Get an at-a-glance look at the most recent portal enhancements
Our portal resources page and UnitedHealthcare Provider Portal enhancements are designed with your workload in mind.

My Practice Profile updates make demographic changes easier
Recent updates make it easier for care providers to submit demographic information through My Practice Profile.

Arizona Medicaid: Electronic appeal/dispute submissions required starting Dec. 1
Health care professionals must submit Medicaid pre- and post-service appeals electronically in Arizona.

Florida Medicaid: Changes to reimbursement rules for diabetic supplies
We’re removing diabetic supplies from the DME fee schedule and will reimburse these supplies as a pharmacy benefit.

Louisiana and Pennsylvania Medicaid: Electronic reconsideration and appeal submission requirement starts Dec. 1
Health care professionals must submit Medicaid medical reconsiderations and appeals electronically in LA and PA.

Maryland Medicaid: Help prevent health care fraud, waste and abuse
We're committed to working with health care providers in our network to keep health care free of fraud and abuse.

New York Medicaid: Enroll with state to avoid claim denials
UnitedHealthcare will deny claims from health care providers who aren’t enrolled with the state Medicaid program. See why.

Updates to pharmacy prior authorization and step therapy requirements
Effective Jan. 1, 2025, Optum Rx will manage pharmacy prior authorizations and step therapy requests for Golden Rule plan.

Navigate colorectal cancer screening options with ease by using our shared decision-making tool
The colorectal cancer screening shared decision-making tool can help educate patients on non-invasive options.

Connect your Medicaid and Medicare patients with SDOH support
Social drivers of health can directly affect patients’ health outcomes. Let’s help disrupt the cycle. See how.