October 01, 2024

October monthly overview

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

October 1 publication

Medical policy updates
Medical policy updates for October 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.

Jan. 1: Electronic reconsideration submissions required
Health care professionals must submit Medicaid claim reconsideration submissions electronically in Arizona.

New radiation therapy requirements for Rocky Mountain Health Plans
On Jan. 1, some UnitedHealthcare requirements and criteria will apply to Rocky Mountain Health Plans.

Dec. 1: Electronic reconsideration and appeal submissions required
Health care professionals must submit Medicaid medical reconsiderations and appeals electronically in Louisiana and Pennsylvania.

Minnesota Medicaid: Your claims may be denied if you’re not enrolled before Oct. 1
See how to avoid claim denials if you’re contracted with a Medicaid MCO or have recently billed as an MCO network provider.

Missouri Medicaid: New state communications portal now available
UnitedHealthcare Community Plan and Missouri partner to launch portal, enhancing Medicaid communication.

New Jersey: Complete survey to avoid credentialing denials
New Jersey care providers are required to complete survey forms to avoid denied credentialing applications.

New York Medicaid: Update your data in My Practice Profile or CAQH
Help patients and other health care professionals find your practice faster by updating your demographic data.

New 2025 Individual Exchange plans and prior authorization information
On Jan. 1, 2025, we'll launch Individual Exchange plans in 4 new states. Learn more.

2025 Medicare Advantage service area changes
On Jan. 1, 2025, we’re making changes to some UnitedHealthcare® Medicare Advantage service areas.

Medicare: Part B step therapy prior authorization requirements
For dates of service starting Jan. 1, 2025, prior authorization is required for Part B Step Therapy Program medications.

Register certain tests for phase 3 of the DEX Z-Codes
Starting Oct. 1, you can register tests that are in scope for phase 3 of the DEX Z-Codes®.

Highlight cultural competencies on your My Practice Profile
Help patients make informed care decisions by updating your practice profile.

Want to save up to $7 and 17 minutes per transaction?
Learn how and when to contact us and use our digital tools for maximum efficiency.

Arizona Medicaid: Be prepared for online VCP statements and claim letters, starting Nov. 8
Beginning Nov. 8, 2024, we’ll no longer mail VCP statements and claim letters to most medical network health care professionals and facilities for UnitedHealthcare Community Plans in Arizona.

California: Respond quickly to medical records requests
California UnitedHealthcare commercial plan care providers must respond to medical records requests.

Louisiana and Pennsylvania Medicaid: Claim letters will no longer be mailed starting Nov. 8
As of Nov. 8, 2024, some Louisiana and Pennsylvania Medicaid claim-related letters will go paperless.

We're now covering certified doula services
Doula services will be covered under the UnitedHealthcare Community Plan of Ohio.

Update your UHC Provider Portal sign-in methods before March 1
A security update to the UnitedHealthcare Provider Portal is coming soon. This will affect how you sign in to the portal and gain access if you’re ever locked out.

Join our Oct. 24 webinar to learn about the Surest resources migrating to UnitedHealthcare
Get all the information you need about Surest benefit plans, including verifying variable copays, updates to the UnitedHealthcare Provider Portal, and the migration to UHC platforms.

Annual interim rate letter submission reminder
Submit your new Centers for Medicare & Medicaid Services (CMS) interim rate letter to ensure correct billing.

Learn more about Medicare outpatient therapies and chiropractic prior authorization requirements
As of Sept. 1, 2024, prior authorization is required for physical therapy (PT), occupational therapy (OT), speech therapy (ST) and chiropractic services delivered in office and outpatient hospital settings.

View the NOMNC determination and delivery
You need to complete the NOMNC process according to Centers for Medicare and Medicaid Services guidelines.

POS edit to prevent therapeutic duplication of GLP-1 medications
As of Nov. 1, 2024, we're adding GLP-1 agonists to the concurrent drug utilization review for Individual Exchange plans.

Help patients who suffer with opioid use disorder
Update your information to let patients know your practice offers medications for opioid use disorder.