November monthly overview
Network News is published monthly. See updates below.
November 1 publication
Policy and protocol updates
Medical policy updates
Medical policy updates for November 2026 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
Georgia: Changes to the state’s weight management program
Effective Oct. 1, 2026, participation in the 9amHealth weight management is optional for members.
Michigan: HIDE-SNP member transition to MI Coordinated Health
Use the primary care appointment availability standards to help HIDE-SNP members.
NJ Medicaid: Consent form required with sterilization claims
UnitedHealthcare Community Plan of New Jersey requires a completed consent form with any sterilization claim.
New Mexico: Taxonomy and ZIP code requirements for claims
Starting in 2027, we’ll begin to reject or deny claims with missing or incorrect taxonomy and/or ZIP codes.
New York Medicaid: Vaccine code list update
On Feb. 1, 2027, New York State Medicaid policy will remove coverage for meningococcal pentavalent vaccines.
North Carolina Medicaid: Support patients with our value-added services guide
Help UnitedHealthcare Community Plan of North Carolina members access extra support with our value-added services guide.
UHC Ohio D-SNPs no longer offered: Review next steps
UHC D-SNP patients may transition to a C-SNP. Provider attestation is required for eligibility.
Pennsylvania Medicaid: Updated reproductive health services guidance
The state may be required to cover medically necessary abortion services and those that don’t qualify for federal funding.
Texas Medicaid: Updated payment policy for acute care readmissions
A member’s readmission to an acute care facility may be considered preventable. Know what can trigger a readmission review.
Washington, D.C.: Change in post-acute care utilization management
On Jan. 1, Care Transitions will begin post acute utilization management of the DSNP plans in Washington, D.C.
Credentialing
Credentialing transitioning to CertifyOS for some states
Learn how CertifyOS will support credentialing and what providers can expect during the transition.
Prior authorization
See how we're making it easier to deliver quality care
Learn how we're reducing administrative burden, simplifying prior authorizations and helping you deliver patient care.
Prior auth simplification efforts continue for members under 18
Beginning Dec. 1, 2026, we’ll remove prior auth requirements for select services for patients under age 18.
Select radiology site-of-service reviews end Dec. 1
On Dec. 1, 2026, radiology site-of-service reviews will end for UHC commercial, Community and Individual Exchange plans.
Medicaid updates
Medicaid: New policy for select embolization procedures
Starting Dec. 1, 2026, a new policy will set coverage criteria for select vascular procedures in KS, KY and NJ.
Medicaid: Expanded prior auth reductions for NE, NJ and TN
Prior auth reductions expand to Nebraska, New Jersey and Tennessee. View the code list and changes.
Plan updates
Florida, Texas and Wisconsin: New UHC Complete Plans
On Jan. 1, 2027, we'll offer new UnitedHealthcare commercial plans in Florida, Texas and Wisconsin.
Commercial plans: Prescription drug list updates for 2027
The Jan. 1, 2027, prescription drug list and pharmacy benefits for UnitedHealthcare commercial plans are now available.
Medical coverage expands for dental care requiring anesthesia
Some UnitedHealthcare medical plans will cover general anesthesia and facility charges for certain dental procedures.
Eligibility and benefits
PCP reassignment feature expands to additional states
Update assigned PCPs in the UHC Provider Portal for eligible Medicaid and Exchange members in participating states.
Education and training
Early health screenings can help close care gaps
Health screening awareness can support earlier detection in American Indian and Alaska Native communities.
