August 01, 2025

August monthly overview

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

August 1 publication

Medical policy updates
Medical policy updates for June 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.

Arizona Medicaid: New test for routine cervical cancer screenings
Self-collected hrHPV testing in a health care setting is recently FDA approved for routine cervical cancer screenings.

California commercial plans: New IVF and related services coverage
On July 1, 2025, the standard benefit will cover IVF and related services for certain UHC commercial plans in California.

Maryland Medicaid: Need language assistance services?
Display our multi-language sign at your practice offering free interpreter assistance in 62 languages.

Maryland Medicaid: See which primary care provider policies have changed
Maryland Medicaid policy updates regarding members’ assigned primary care providers and eligibility.

Nebraska Medicaid: Submit reconsideration and appeal requests electronically
Starting Sept. 1, 2025, you should submit claim reconsiderations and medical pre- and post-service appeals electronically.

New Jersey Medicaid: Tell us how you use technology
Help us learn more about your practice and the technology you use.

North Carolina Medicaid: Use casting supplies code A
Claims submitted with an incorrect casting supplies code will be denied.

Pennsylvania: No copays for Medicaid members starting July 1
Medicaid members are no longer responsible for copays on any services, effective July 1, 2025.

Rhode Island Medicaid: Prior authorization for outpatient therapies
Prior authorization updates for outpatient PT, ST, and OT are expanding to Rhode Island Medicaid members Nov. 1.

Texas Medicaid: New medication criteria and prior authorization updates
The state has recently announced new medication criteria and prior authorization guidelines for certain medications.

National Gold Card program: New year, newly eligible groups
National Gold Card program reducing prior authorizations for providers continues into year two. New protocol available.

Coverage changes for OneTouch meters and test strips
Preferred alternatives of diabetic testing supplies by plan. Effective dates vary, starting in 2025.

Action required: Radiology prior authorization requirements for APWUHP members
American Postal Workers Union require prior authorizations for high-end radiology services for their members.

Avoid reimbursement reduction for late admission notification
Help ensure your facility is fully reimbursed. See the required steps for member admission and the notification timeline.

Medicaid: Required documentation changes for hip and knee total joint replacements
Beginning Oct. 1, 2025, we’ll require additional documentation for total joint replacements.

Action requested: Increasing colorectal cancer screenings for patient populations
We offer valuable tools to help your discussions with patients about colorectal cancer screenings.

Individual Exchange plans: Help ensure patients can schedule timely appointments
Participating Individual Exchange plan health care providers are required to meet the CMS appointment wait time standard.

Save time submitting reconsiderations and appeals with our resources
Access information, interactive guides and frequently asked questions on the appeal and reconsideration processes.

See how APIs can save time for your whole team
Learn how APIs can help you streamline your workflow to save time throughout the day.