August monthly overview
Network News is published twice a month. See updates below.
August 1 publication
Policy and protocol updates
Medical policy updates
Medical policy updates for August 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.
Gold Card program
UnitedHealthcare national Gold Card program protocol
Gold Card program protocol announcement modifying prior authorization and advance notification requirements.
State news
Arizona Medicaid: VCP statements and claim letters going paperless
Starting Nov. 8, VCP statements and claim letters are going digital for Arizona Medicaid members.
Arizona: No referrals required with HMO Open Access
As of Jan. 1, 2024, all of our Medicare HMO H0609 plans no longer require referrals.
Required clinical guideline updates for RMHP
Colorado Rocky Mountain Health Plans care providers can now view annual clinical guideline updates.
New online utilization management requirement
Starting Sept. 1, submit utilization management requests online for patients delegated to Optum Care Network in KS and MO.
Michigan Medicaid: Treating pregnant individuals and infants
Michigan Medicaid offers free supplementary services to pregnant individuals and families with infants. See how and pass it on.
New Jersey Medicaid: Starting, July 1, denied claims are not automatically reprocessed
We will stop automatically reprocessing denied claims if you are registered for the 21st Century Cures Act program.
Prior authorization requirement changes for radiation therapies
Starting Nov. 1, 2024, we’ll require prior authorization for some outpatient radiation therapies in New York.
Texas Medicaid: Enroll to receive your enhanced LTSS rate
Sign up annually during the enrollment period to be eligible for the Attendant Compensation Enhancement Program (ACEP).
Texas Medicaid: State-required prior authorization updates for medications
Starting Sept. 1, 2024, we’re updating prior authorization requirements for certain medications. See our chart for links.
Prior authorization updates
Outpatient therapy and chiropractic prior authorization requirements
Medicare Advantage plans nationally will require prior authorization for outpatient therapy and chiropractic services.
At your fingertips: Individual Exchange updates
Access a variety of resources to help you work with us as you care for members who have these state-specific plans.
Miscellaneous news
UHC Provider Portal: Upload attachments for professional/institutional claims at submission
Learn how to use Claim Submission to enter claims electronically for professional or facility/institutional claims.
Molecular test registration phase 2 begins on Aug. 1
The new Molecular Pathology Policy, Professional and Facility, test registration for phase 2 begins on Aug.1.
August 15 publication
State news
Trellus Elevate: Empower your patients with personalized IBD support
Your New York and Connecticut IBD patients can enroll in Trellus Elevate until Sept. 1.
Florida Medicaid: AHCA will terminate unregistered provider IDs Sept. 1
Florida Agency for Health Care Administration will terminate registered provider IDs not enrolled with Florida Medicaid.
Sept. 1: Electronic reconsideration and appeal submissions required
Health care professionals must submit Medicaid medical reconsiderations and appeal submissions electronically in MN and VA.
Explore the Think Cultural Health training by Oct. 1
Medicaid health care professionals need to take the Think Cultural Health training by Oct. 1.
Texas Medicaid: Postpartum coverage extended to 12 months
Postpartum coverage effective March 1, 2024, extended from 2 months to a year for Medicaid and CHIP recipients.
Sept. 13: Several documents going paperless
VCP statements and overpayment and claim letters are going digital for Virginia Medicaid members.
Washington Medicaid: Preeclampsia awareness project
Patients taking part in the Blue Band initiative wear blue wrist bands to signify they're at risk for preeclampsia.
Policy and coverage changes
Outpatient therapy and chiropractic prior authorization requirements
Medicare Advantage plans nationally will require prior authorization for outpatient therapy and chiropractic services.
Nutropin AQ NuSpin to be discontinued
Effective Jan. 1, 2025, most UnitedHealthcare plans will no longer cover Nutropin AQ NuSpin. Explore alternatives.
Choice Plus network updates
Prepare for these new Choice Plus network members
The Salvation Army – Southern Territory members have access to the Choice Plus network on June 1, 2024.
More Choice Plus plan members may be coming to your practice
The Connecticut Pipe Trades Health Fund members have access to the Choice Plus network as of July 1.
Other news
The Medicare Advantage Coverage Summary applies to certain wound treatments, skin substitutes
View our Medicare Advantage Coverage Summary for skin substitutes.
Make a difference this Transgender History Month
Complete our free CME course and update your practice profile information to show your support.
Preferred Methods for Submitting Your Demographic Data
As of Oct. 1, 2024, we are eliminating email as an intake option to maintain your demographic data.
Announcements
Unlock your 2024 United Hero potential
Discover how to be recognized for providing excellent patient experiences. Order your free Hero Kit today.
Hospital quality measures guide
Get key information for hospital-related quality measures FMC, PCR and TRC, including how to report data and billing codes.
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