May monthly overview
Network News is published once a month. See updates below.
May 1 publication
Policy and protocol updates
Medical policy updates
Medical policy updates for May 2025 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
Expanded member benefits help make health care better for everyone
Learn about expanded benefits for community plan members in FL that enhance patient care, offer more provider resources.
Claim-related documents going paperless for Kansas and Nebraska Medicaid
As of June 6, 2025, some Kansas and Nebraska Medicaid claim-related letters will go paperless.
What you need to know about the updated primary care attribution process
Attribution process performs quarterly 24-month claim look-backs to ensure members are assigned to the appropriate PCP.
June 6: Several documents going paperless
More letters and reconsiderations, pre-/post-service appeals going digital for Kentucky, Washington, D.C., Medicaid.
Changes to Peoples Health prior authorization submission process
Starting July 1, Peoples Health is changing the prior authorization submission process for certain Part B drugs.
Zepbound and phentermine added to preferred drug list
In January 2025, we made policy updates for weight-loss and obesity medications for certain Massachusetts plans.
New York Medicaid: Referrals not required for most specialty services
Referrals for New York Medicaid members are required for only certain specialty services. View the latest requirements.
New York Medicaid – Prenatal and postpartum services require Category II CPT® codes
Submit claims with Category II CPT codes for prenatal/postpartum services to comply with NY state guidelines.
New ORP claim denials for UnitedHealthcare Community Plan of Ohio
New ORP claim edits start May 1, 2025. Include NPI to avoid Y42 denials.
Electronic reconsideration and appeal submissions required
Starting June 2, 2025, you’ll be required to submit claim reconsiderations and medical pre- and post-service appeals electronically.
Ohio: Use EVV platform for home health services to avoid claim denials
Register with Sandata and begin to use the state’s EVV system to avoid claim denials beginning on June 1.
Aug. 1: Electronic reconsideration and appeal submissions required
Health care professionals must submit medical reconsiderations and appeals electronically in Texas.
Process and policy updates
Synapse Health will soon manage DME orders
On Aug. 1, you’ll use Synapse Health for durable medical equipment orders in certain states.
Streamline claims with EDI 275 claim attachments
Unsolicited EDI 275 claim attachments now available with the Availity clearinghouse.
New changes: Close FUA and FUM gaps using qualified billing and diagnostic codes
You help can close FUA and FUM gaps using qualified billing and diagnostic codes.
Submission of medical record documentation for Surgery of the Hip and Knee
CPT codes 27445, 27447, 27130 and 27132 will have additional documentation requirements, starting Aug. 1 for IFP.
New UnitedHealthcare mailing address for contract notices
UnitedHealthcare has a new mailing address for contract-required notices.
Prior authorization changes
Maryland Medicaid: New prior authorization requirements for 2 types of NIPT
On June 1, we’ll require prior authorizations for certain types of Noninvasive prenatal testing.
Digital updates and resources
Streamline your health care practice with technology
Use APIs for more efficient, secure care coordination.
Start integrating behavioral health into your primary care setting
Training series on behavioral health identification, treatment and referral in primary care available for CME credit.
Update your status: Are you taking new patients?
Keep your provider directory up to date to help ensure patients know whether you’re accepting new patients.
Announcements
Student Resources PRAs added to Document Library
Starting May 21, provider remittance advices (PRAs) won’t be mailed. Access them 24/7 in the Payment Documents folder.
