September monthly overview

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

September 1 publication

Medical policy updates
Medical policy updates for September 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.

Introducing a first-of-its-kind national Gold Card program
New National Gold Card program may reduce prior authorizations for high-performing providers.

Dec. 1: Electronic appeal submissions required for Arizona Medicaid
Health care professionals must submit Medicaid pre- and post-service appeals electronically in Arizona.

Nov. 8: Claim-related documents going paperless for Louisiana and Pennsylvania Medicaid
As of Nov. 8, 2024, some Louisiana and Pennsylvania Medicaid claim-related letters will go paperless.

New online utilization management requirement
You will be required to submit utilization management requests online for patients delegated to Optum Health Networks.

Maryland Medicaid: State-required updates to specialty pharmacy prior authorization requirements
Starting Dec. 1, 2024, we will require prior authorization for some specialty medications for Medicaid members in Maryland.

New Jersey: Submit your medical records documentation for annual review
Annual medical record reviews are underway with UnitedHealthcare Community Plan of New Jersey care providers.

New Jersey Medicaid: 2 options for submitting HCBS T1001 claims
Home- and community-based service providers now have 2 options for filing claims for CPT® code T1001. Learn more.

New Jersey: NJPMP checks required
UnitedHealthcare Community Plan of New Jersey health care professionals are urged to check the NJPMP database.

New GA modifier requirement for UnitedHealthcare commercial plans
Beginning Feb. 1, 2025, we’re updating the Charging members for non-covered services protocol with a new requirement.

Want to see the portal enhancements specific to your role? You can.
Our portal resources page and the UnitedHealthcare Provider Portal enhancements page are designed with your workload in mind.

Take charge of your time
Learn how and when to contact us and use our digital tools for maximum efficiency.

Explore the latest immunization best practices in our guide
Learn about immunization best practices and strategies, including scheduling, milestones and more.

New protocol updates available for the National Gold Card program
The National Gold Card program recognizes qualified practices that have consistently demonstrated adherence to evidence-based guidelines.

New Jersey Medicaid: Consent form required with any sterilization claim
Per state guidelines, UnitedHealthcare Community Plan of New Jersey requires a consent form with any sterilization claim.

North Carolina Medicaid: End dates corrected on some prior authorizations
Prior authorizations may be delayed for some members transitioning from the state’s Medicaid program. See what you can do.

Texas Medicaid: Log ImmTrac2 consent to submit immunization records
Texas Immunization Registry tracks vaccine records for Texas children and helps improve continuity of care.

Texas Medicaid: State-required prior authorization updates for medications
Effective Oct. 1, 2024, we’re updating clinical prior authorization criteria guides for certain medications. See our chart.