December monthly overview
Network News is published once a month. See updates below.
December 1 publication
Policy and protocol updates
Medical policy updates
Medical policy updates for December 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
Arizona Medicaid: Explore pediatric and perinatal care resources
View our perinatal and pediatric psychiatry resource for UnitedHealthcare Community Plan of Arizona members.
Arizona Medicaid: New coverage details for cochlear implants and speech therapy
AHCCCS is now covering medically necessary cochlear implants and speech therapy for members who are 21 and over.
Massachusetts Medicaid: Updated guidance for MassHealth encounter data requirements
Avoid claim rejections, denials and reimbursement delays. Ensure your claims have complete and accurate data. See how.
New Mexico Medicaid: Gross receipt taxes reimbursed for services
Effective Jan. 1, 2026, MCOs must reimburse health care providers for gross receipts taxes they pay on Medicaid services.
North Carolina Medicaid: Test for routine cervical cancer screenings
Self-collected hrHPV testing in a health care setting is recently FDA approved for routine cervical cancer screenings.
Texas Medicaid: New NEMT transportation vendor in January
Starting Jan. 1, 2026, SafeRide Health will provide non-emergency medical transportation for Texas Medicaid.
Virginia: Send contract notices to our new email address
Beginning Jan. 1, 2026, you must submit contract notices electronically to our new email address.
Washington Medicaid: Important updates to our primary care attribution process
Quarterly, 24-month claim look-backs ensure members are assigned to the appropriate PCP.
Medicare plan updates
2026 Medicare Advantage plan updates
Discover what’s changing in UnitedHealthcare Medicare Advantage plans for 2026.
Medicare: Change in post-acute care management in 3 states
On Jan. 1, 2026, UnitedHealthcare will begin to manage the Medicare component of HIDE or FIDE-AIP in 3 states.
Medicare SNP: Verification of chronic condition begins Jan. 1, 2026
As of Jan. 1, 2026, SNP members will need a documented qualifying chronic condition to access food and/or utility benefits.
Medicare: Vyndaqel will be discontinued on Dec. 31
Pfizer announced they’ll discontinue Vyndaqel on Dec. 31, 2025, which will affect UnitedHealthcare Medicare members.
New Medicare Advantage referral requirement in 2026
Starting Jan. 1, 2026, PCP referrals will be required for specialist visits under most UnitedHealthcare Medicare Advantage HMO/HMO-POS plans.
Upcoming Medicare prescription drug formulary and plan changes
On Jan. 1, 2026, prescription benefit and formulary changes go into effect for some UnitedHealthcare Medicare members.
Prior authorization updates
No prior authorizations required for some radiology and cardiology procedures
Certain nuclear imaging, obstetrical ultrasound and echocardiogram procedures will no longer require prior authorization.
Updated documentation guidelines for cardiac ablation procedures
Starting Jan. 1, 2026, more documentation may be needed for cardiac ablation procedure prior authorizations.
Medicaid: Required documentation changes for hip and knee total joint replacements
New states require additional documentation for total joint replacements starting Jan. 1, 2026.
Program and health plan updates
New drug list and pharmacy benefits for commercial plans
View the pharmacy drug list and benefit updates for UnitedHealthcare commercial plans, effective Jan. 1, 2026.
Get ready for more Choice Plus network members
Indiana Laborers Welfare Fund members have access to the Choice Plus network on Dec. 1, 2025.
Cancer Therapy Pathways discontinues reward incentive
On Jan. 1, 2026`Cancer Therapy Pathways reward incentives will no longer be available.
Digital platform updates
Manage claim overpayments in the Electronic Payment Portal
Optum Recoveries offers a secure, easy-to-use online portal for providers needing to repay claim overpayments.
New! Use TrackIt to submit documentation for pended claims
Instead of mailing us documents for pended claims, you can submit them online. Get faster results with TrackIt.
Resources for member care
Discover the best colorectal cancer screening method
Use our shared decision-making tool to help navigate your patient’s colorectal cancer screening options.
Act now: Screen patients for SDOH by Dec. 31
Screen patients for gaps in food, housing and transportation, then report results to connect them with support programs.
Join a Surest webinar for essential plan information
Learn about the Surest plan, variable copays and digital resources in the UnitedHealthcare Provider Portal.
