August monthly overview

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

August 1 publication

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.

UnitedHealthcare national Gold Card program protocol
Gold Card program protocol announcement modifying prior authorization and advance notification requirements.

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.

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.

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.

Get key information for hospital-related quality measures FMC, PCR and TRC, including how to report data and billing codes.

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