April monthly overview
Network News is published once a month. See updates below.
April 1 publication
Policy and protocol updates
Medical policy updates
Medical policy updates for April 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
Massachusetts Medicaid: Prior authorization, HCPCS coding and member ID updates
We’ve updated prior authorization requirements for home health services, HCPCS coding rules and member IDs.
Michigan Medicaid: How to avoid denied community health worker claims
CHW claims denied due to incorrect data and provider non-enrollment are on the rise. Learn how to fix them.
New Jersey Medicaid: Billing our members for covered services is not permitted
Balance billing members is a violation of your agreement and New Jersey law. See how to stay compliant.
New Jersey Medicaid: Fall risk screening in elderly patients
Learn more about elderly fall risk factors, screening details and prevention strategies.
New Mexico Medicaid: Use new payer ID beginning March 23
New Mexico HCA and MAD launched a new claims management system on March 23, 2026. Learn about payer ID updates and more.
New York Medicaid: No referrals needed for specialist visits
As of Jan. 1, 2026, we no longer require referrals for follow-up visits with select specialist categories.
North Carolina Medicaid: State upholds EVV requirements for PCS providers
Personal care service providers must transmit EVV data to the health plan’s EVV vendor. Here’s how.
OhioRISE enrollment and eligibility change
Starting July 1, enrollment will begin the first day of the eligibility month.
Pennsylvania Medicaid: Certification now required for community health workers
HealthChoices requires community health worker certification for Medicaid partners as of Jan. 1, 2026.
Pennsylvania Medicaid: Revalidate Medical Assistance enrollment every 5 years
Medical Assistance providers must revalidate enrollment for each service location every 5 years to avoid disruptions.
Texas Medicaid: CLIA certification must be current and active in PEMS
Laboratory claims submitted without verifiable CLIA data will be denied. Learn what’s needed for service reimbursement.
Prior authorization
Medicaid: Prior authorization required for certain transcatheter heart valve procedures
On July 1, we’ll require prior authorization for 2 transcatheter heart valve services for UnitedHealthcare Community Plans.
Medicaid: View new genetic and molecular code updates
View the genetic and molecular codes added to and removed from our prior authorization requirements.
National Gold Card codes updated to reduce prior authorizations
The national Gold Card list has been updated to remove certain codes from requiring prior authorization.
New genetic and molecular codes required for prior authorization
New genetic and molecular codes for prior authorization for UnitedHealthcare commercial and Individual Exchange Plans.
Grouper exhibit updates
Outpatient Procedure Grouper Exhibit annual reimbursement update, effective July 1
Review the 2026 Outpatient Procedure Grouper (OPG) Exhibit for annual changes to reimbursement.
Digital enhancements
Expanded list of vendors for EDI 275 unsolicited claim attachments
Now, more clearinghouses can securely submit EDI 275 unsolicited claim attachments. See why it’s better than using mail.
Education and programs
Recognize your team: The 2026 United Hero Kit has arrived
Order your free Hero Kit for a full set of resources designed to help you and your team enhance patient experiences.
National Minority Health Month: Addressing social drivers of health
SDOH affects the health and well-being of patients in racial and ethnic minority communities. See how to make a difference.
