July monthly overview
Network News is published once a month. See updates below.
July 1 publication
Policy and protocol updates
Medical policy updates
Medical policy updates for July 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: Vaccines for Children annual re-enrollment requirement
Providers enrolled in the Arizona Vaccine for Children’s Program (VFC) must re-enroll by August 31.
California: Verify your data to remain in our provider directories
Please confirm or update your demographic data to avoid directory removal.
Hawaii Medicaid: Several claim-related documents going paperless
Starting Oct. 3, a number of claim-related documents will go paperless for Hawaii Medicaid.
Kansas Medicaid: Submit reconsideration and appeal requests electronically
Health care professionals are encouraged to submit Medicaid reconsiderations and appeals electronically in Kansas.
Kentucky Medicaid: VCP statements are going digital Oct. 3
Starting Oct. 3, 2025, we’ll no longer mail VCP statements to Kentucky.
Maryland Medicaid: VCP statements, claim letters are going digital
Starting Oct. 3, VCP statements and claim letters are going digital for Maryland Medicaid members.
Maryland Medicaid: Electronic reconsideration, appeal submissions required starting Aug. 1
Health care professionals must submit Medicaid medical reconsiderations and appeals electronically in Maryland.
Maryland Medicaid: Optum to manage physician-administered drug prior authorizations
As of Sept. 1, 2025, Optum will manage prior authorization for non-oncology injectable medications for Maryland Medicaid.
Michigan Medicaid: Complete the In Lieu of Services nutrition prior authorization form
Complete the new In Lieu of Services nutrition prior authorization form to help members who need food services.
Nebraska Medicaid: Enrollment with the state is required for reimbursement
Health care providers must be registered with Nebraska Medicaid at each business location to avoid claim denials. See how.
New York Medicaid: Get free CEU credits for required cultural competency training
Take this free online course for an overview of how to meet your patients’ cultural, health literacy and language needs.
New Jersey and New York: More Choice Plus plan members may be coming to your practice
Stone Derrickmen & Riggers Local 197 members have access to the Choice Plus network on June 1, 2025
New Jersey Medicaid: Provision request is required for some DME prior authorizations
You’ll need to request an exceptional circumstances provision when submitting prior authorizations for durable medical equipment.
North Carolina Medicaid: New state code required for obstetrical services claims
On July 1, you’ll need to use F codes to provide prenatal and postpartum care services to UnitedHealthcare Community Plan of North Carolina members.
Texas Community Plan: Electronic reconsideration, appeal submission requirement starts Aug. 1
Health care professionals must submit medical reconsiderations and appeals electronically in Texas.
Texas Medicaid: Celebrate excellence in attendant care — Nominate today
Help recognize outstanding care. Nominate an exceptional caregiver for the 2025 REACH Award.
Texas Medicaid: We’re expanding our hearing aid provider network
Starting Sept. 1, our hearing aid provider network will expand to include HearUSA providers.
Prior authorization and medical policy updates
Updates to Medicare Part D formularies: Substitution of Stelara with 2 interchangeable biosimilars
Summary description: On June 1, 2025, Stelara was replaced by 2 interchangeable biosimilar products for Medicare Part D plans.
Synapse Health will soon manage DME orders in select states
On Oct. 1, you’ll use Synapse Health for durable medical equipment orders in certain states
Medicaid: View new AMA genetic and molecular codes
View the added genetic and molecular testing CPT® codes from the American Medical Association.
Reimbursement updates
Medicare Advantage: Reimbursement update for Advanced Practice Health Care Practitioners
Follow Medicare billing guidance when submitting claims for Advanced Practice Health Care Practitioners.
Plan and policy updates
Action needed: Close hospitalization for mental illness gaps
Use qualified billing and diagnostic codes to close the follow-up after hospitalization (FUH) for mental illness HEDIS® gaps.
Be prepared: Annual federal audit of commercial plans launching soon
You may be randomly selected to provide documentation for the annual HHS-RADV audit program.
2025 Patient Experience: Explore new practice change strategies
Explore patient experience best practices, CAHPS/HOS and actionable practice change strategies
Digital tools and resources
Earn CME credits during Chronic Disease Awareness Month: Obesity
Heath care professionals will learn how to address cultural and social factors that link to cause obesity and diabetes
Save time - automate your work with our secure APIs
Use APIs for more efficient, every day transactions
Lab updates
Available now: The July 1 Preferred Lab Network roster
View the current Preferred Lab Network providers.
CPT® is a registered trademark of the American Medical Association.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
