Complete Story
02/24/2026
Coding and Compliance Updates
Your guide to changes in coverage and reimbursement, with resources
United Healthcare UCard Changes
Several members have inquired about changes to the United Healthcare Ucard, a Medicare Advantage Dual Special Needs Plan. Starting Jan. 1, 2026, most members enrolled in UnitedHealthcare Medicare Advantage HMO and HMO-POS plans will be required to obtain a referral from their primary care provider (PCP) before accessing certain specialist services in outpatient, office or home settings. Referrals must be submitted by the PCP to UnitedHealthcare prior to the specialist visit. You can choose a start date of up to 5 calendar days prior to the entry date. Referrals are effective immediately upon submission.
The new referral requirements do NOT apply to services provided by a podiatrist - Referral requirements for Medicare Advantage HMO/HMO-POS plans Jan. 1, 2026 | UHCprovider.com
Resources
- Get answers to your questions about referral requirements: 2026 UnitedHealthcare Medicare Advantage Referral Requirements Guide
- Get updated plan information: 2026 Medicare Advantage, CSNP & DSNP Plan Overview Course
Members or patients who have any issues with access to care for podiatry services, can file a grievance with UHC directly using the UnitedHealthcare Medicare Plan Appeals & Grievances Form at UnitedHealthcare Medicare Plan Appeals & Grievances Form - UnitedHealthcare.
CareSource Reimbursement Schedule
OHFAMA members have reached out from across the state, noting a letter from CareSource detailing a significant fee reduction in the reimbursement schedule for podiatry.
As your professional association, OHFAMA is working hard behind the scenes through several different avenues to ensure you are reimbursed fairly. Updates will be communicated when available. Please contact our office if you have any questions.
APMA Skin Substitutes Resources
Learn how skin substitute payment reforms impact your practice. On February 11, 2026, APMA presented, Skin Substitutes: Compliance and Coverage Changes for 2026. The following presenters hosted:
- Cindy Moon, MPP, MPH, Vice President, Hart Health Strategies
- Jeffrey Lehrman, DPM, CPC, Advisor, APMA Advocacy Department
- Ira Kraus, DPM, CFACS, APMA AMA CPT Editorial Panel / President, Talar Medical
- Andrew Pavelescu, DPM, APMA Alternate RUC Advisor / APMA Coding Committee
Next Generation MyCare Ohio
At the beginning of January 2026, Next Generation MyCare plans combined all Medicare and Medicaid benefits into a single plan. This change is designed to improve coordination of benefits and support, making it easier for members to get the care they need. The program is designed to simplify access to care for more than 250,000 Ohioans by integrating Medicaid and Medicare services under one streamlined system.
Visit the Resources for Providers | Medicaid to learn more about the Next Generation of Ohio Medicaid program and what it means for providers, including available resources to support you in utilizing new systems and features. To see the official roll out map for the state and to learn more, please follow this link …read more…Link to previous story with map…however you want to word it/link it, etc.
Free resources are also available through RetireMed - Medicare Webinars - Answers To Your Questions | RetireMed?
