11/13/2023
United Healthcare
United Healthcare Managed Care Committee Member
Shelby Jensen, CHONC - Newland Medical Associates
General
You can access the Medical Benefit Specialty Drug Update Bulletin for the latest updates on drugs added to review at launch, program requirements, and policies. Click through for complete details.
Prior Authorization Reduction Equals Nearly 20 Percent of Overall Volume
While we’ll remove some codes across select benefit plans, there will be differences. Please consult the list that aligns to each specific benefit plan:
- UnitedHealthcare Commercial plans
- UnitedHealthcare Oxford plan
- UnitedHealthcare Individual Exchange plans
- UnitedHealthcare Medicare Advantage plans
- UnitedHealthcare Community Plan
Feb. 1: Reconsideration and Appeal Submissions Going Digital-Only
Beginning Feb. 1, 2024, you’ll be required to submit claim reconsiderations and medical pre- and post-service appeals electronically. This change affects most* network healthcare professionals (primary and ancillary) and facilities that provide services to UnitedHealthcare Community Plan (Medicaid) plan members.
UHC Commercial
- Medical Policy Update Bulletin: November 2023
- Oxford Policy Update Bulletin: November 2023
- West Benefit Interpretation Policy Update Bulletin: November 2023
- West Medical Management Guideline Update Bulletin: November 2023
- UMR Policy Update Bulletin: November 2023
- Reimbursement Policies Update Bulletin: November 2023
Community Plan
UHC Medicare Advantage
- Coverage Summary Update Bulletin: November 2023
- Policy Guideline Update Bulletin: November 2023
- Reimbursement Policies Update Bulletin: November 2023