April monthly overview

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

April 1 publication

Policy and protocol updates

Medical policy updates
Medical policy updates for April 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

Outpatient therapies prior authorization program for Medicare Advantage expanding to Arizona, Colorado and Oklahoma
The prior authorization requirement for outpatient PT, OT, ST and traditional Medicare chiropractic services is expanding to specific plan members in Arizona, Colorado and Oklahoma starting July 1, 2025.

Earn $100 incentive with SBIRT
Use SBIRT during the first visit with pregnant patients to earn $100 incentive.

June 6: 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.

Maryland Medicaid: Discarded drugs and biologicals reimbursement policy update
Starting May 1, 2025, UnitedHealthcare Community Plan of Maryland will recognize modifier JZ. Learn more.

New Jersey Medicaid: Prior Authorization is required for all Personal Care Assistance services
Per state guidelines, prior authorization is required for all PCA services administered to New Jersey Medicaid members.  

Ensure PCP assignment to avoid reimbursement denial
UHCCP members must visit a PCP in the same practice (same tax ID) as the PCP listed on their ID card.

New York Medicaid enforces NDC requirements for claims with HCPCS J-codes
Claims for J-code drugs with a UD modifier must include the corresponding NDC to avoid denials.

North Carolina: Initiated transfer and paper claims submission update
Review the updated process for submitting initiated transfers and paper claims in North Carolina.

North Carolina Medicaid: Reimbursement rate changes for personal care services
See how to bill with per diem pricing for personal care services rendered to members living in congregate settings.

Rhode Island Medicaid: OAE testing is not medically necessary for routine hearing screening
Use otoacoustic emissions (OAE) testing only for infants, children under age 4 and some adult populations. Learn why.

Texas Medicaid: State-required medication prior authorization updates
Effective May 1, 2025, we’re updating Texas Medicaid clinical prior authorization criteria for certain medications.

Prior authorization updates

View the genetic and molecular codes added to prior authorization requirements
Additional genetic and molecular codes will be added for UnitedHealthcare Community.

Grouper exhibit updates

UnitedHealthcare Outpatient Procedure Grouper Exhibit annual reimbursement update
Review the 2025 Outpatient Procedure Grouper (OPG) Exhibit for annual changes to reimbursement.

Digital enhancements

UnitedHealthcare Provider Portal resources
Work more efficiently without calling. Check out our digital solutions and latest digital enhancements.

APIs can save time for your whole team
Learn how APIs can help you streamline your workflow to save time and focus more on patient care.

United Heroes news

The 2025 Hero Kit is now available
Order your free Hero Kit to receive comprehensive resources you and your team can use to help improve patient experiences.

Announcements