October 01, 2025

October monthly overview

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

October 1 publication

Medical policy updates
Medical policy updates for October 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.

California HMO commercial: New member ID cards for SignatureValue plans
New member ID cards for California SignatureValue plans will be issued in phases beginning Oct. 1, 2025.

DC Medicaid: DME prior authorization update
Community Plan DME prior authorization rules for aligning with D-SNP requirements effective Oct. 1, 2025.

Idaho Medicaid: New prior authorization requirements for radiation services
On Jan. 1, 2026, we’ll require prior authorizations for outpatient chemotherapy and radiation therapy services.

Individual commercial health plans in Georgia
New UHC Complete plans available statewide beginning Jan. 1, 2026.

Maryland Medicaid: Pregnant individuals must complete the MPRA form
Pregnant individuals enrolled in Medicaid and at-risk for health and social concerns may be eligible for certain services.

New York custodial care — Reminder of Medicaid eligibility requirements to avoid payment recovery
Reimbursements to nursing homes will be recovered if an LTSS application is incomplete or the member is found ineligible.

Texas Medicaid: State-required medication prior authorization and clinical criteria updates
On Oct. 15, 2025, we’re updating Texas Medicaid clinical prior authorization clinical criteria for certain medications.

Texas Medicaid: Changes made to STAR+PLUS billing codes and modifiers
Effective Sept. 1, 2025, long-term care providers must use new billing codes and modifiers as members’ care plans renew.

Texas Medicaid — Register for LTSS virtual town hall
Learn about online claim and authorization tools, Electronic Visit Verification, fraud prevention and value-added services.

Updates to Individual Exchange plans PDLs on Jan. 1, 2026
Effective Jan. 1, 2026, we’re making changes to the prescription drug lists for UnitedHealthcare Individual Exchange plans.

Medicare Advantage update: Referrals required starting Jan. 1, 2026
Most UnitedHealthcare Medicare Advantage HMO/HMO-POS members will need a PCP referral before seeing a specialist.

Medicare: Avoid denials for heart failure management claims
View the claim submission process for implantable pulmonary artery pressure sensors for heart failure management.

2026 Medicare Advantage service area changes
On Jan. 1, 2026, we’re making changes to some UnitedHealthcare Medicare Advantage service areas.

Medicare Part B: Step therapy prior authorization updates
Part B step therapy program prior authorization updates effective Jan. 1, 2026.

Updates to Special Needs Plans SSBCI member enrollment and verification
As of Jan. 1, 2026, SNP members will need a documented qualifying chronic condition to access food and/or utility benefits.

New AMA codes for genetic and molecular prior authorizations
AMA issued new genetic and molecular codes that we’re adding to our genetic and molecular prior authorization program.

Experience our dynamic, live Smart Edits CLIA training
Discover the Smart Edits that are active for Clinical Laboratory Improvement Amendments with our interactive training.

Earn CME credits with our substance use disorder training
Take our substance use disorder training to view the latest practice insights and earn free CME credits.

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Our supercharged digital connectors simplify your workflow and help prevent delays.