Search

November 01, 2024

November monthly overview

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

November 1 publication

Policy and protocol updates

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.


State news

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.


Prior authorization updates

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.

Medicare Advantage: Prior authorization resources for outpatient therapy and chiropractic services
View helpful resources regarding prior authorization for PT, OT, ST and chiropractic services.


Plan and process updates

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.


Prescription drug list updates

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.


UHC Provider Portal enhancements

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.


Announcements

Jan. 1, 2025, Prescription Drug List Updates

Access the latest Prescription Drug List and pharmacy benefit updates for UnitedHealthcare commercial plans.

View the list Jan. 1, 2025, Prescription Drug List Updates

PCA-1-24-01032-MarComm-NN_102224

Finding news icon

Discover more news

Personalized news icon

Get personalized news