UnitedHealthcare Community Plan of Texas: New Medicaid billing process

Services and medication for D-SNP members

Effective Sept. 1, 2025, bill UnitedHealthcare Community Plan of Texas directly for Medicaid-covered (Medicare wraparound coverageopen_in_new) services and medication for Dual Special Needs Plan (D-SNP) members. All changes are mandated by Texas House Bill 1open_in_new (Art. II, HHSC, Rider 32). 

Key changes include:

• Texas Health and Human Services Commission (HHSC) will no longer handle billing or prior authorization for Medicaid-covered services 
• Wraparound medication will switch from fee-for-service (FFS) to the HHSC rate. This change includes over-the-counter medications, cough and cold relief products and some prescription vitamins and minerals. Optum Rx® will manage billing for medications.
• Medicaid-covered services will switch from FFS to managed care billing based on the HHSC rate
• Services provided through FFS for Medicaid-only beneficiaries, like pediatric nursing facility services, will not be affected

Prior authorization

Some services and medications need prior authorization. If they already require prior authorization, the requirement should not change.  You can submit a prior authorization request through the UnitedHealthcare Provider Portal:

Go to UHCprovider.com and select Sign In at the top-right corner

• Sign in to the portal using your One Healthcare ID and password 
  • If you are a new user and don’t have a One Healthcare ID, visit the provider portal registration page to get started
• In the menu, select Prior Authorizations
• In the Prior Authorization and Notification tool, scroll down to “Create a new notification or prior authorization request” and click Create New Submissions
• Enter the required information and submit

Learnopen_in_new more about using the UnitedHealthcare Provider Portal for prior authorization.

Additional resources

• Listopen_in_new of procedures codes for services requiring prior authorization
• View a listingopen_in_new  all the Rider 32 procedure codes and descriptions

Questions?

Please contact your Provider Advocate or call UnitedHealthcare Community Plan of Texas Customer Service at 888-887-9003, 8 a.m.–6 p.m. CT, Monday–Friday.