Texas Medicaid MCOs are required to deliver all medically necessary services covered by Medicaid to their enrolled members. Administrative processes like prior authorization, precertification, referrals, claims, or encounter data submission may vary from traditional Medicaid (fee-for-service) and between different MCOs. Providers should reach out to the member’s specific MCO for more information. On May 27,… Continue reading Hospital Outpatient Imaging and Indian Health Services Fee Schedule Has Been Updated
Archives: Newsletter
AARP Healthcare Options Provider Website Has Moved to a New Address
Start using the UnitedHealthcare Provider Portal to access AARP Medicare Supplement member information now. The AARP Healthcare Options Provider website will shut down on June 30, 2025. Sign up for the UnitedHealthcare Provider Portal before this date to ensure seamless administrative and patient care services. What You Need to Know You can now view AARP®… Continue reading AARP Healthcare Options Provider Website Has Moved to a New Address
Texas Medicaid Updates Billing Process for UnitedHealthcare Community Plan
Starting September 1, 2025, direct all billing for Medicaid-covered services and medications, including Medicare wraparound coverage, for Dual Special Needs Plan (D-SNP) members to UnitedHealthcare Community Plan of Texas. These updates are required under Texas House Bill 1 (Article II, HHSC, Rider 32). Key Updates to Medicaid Billing and Services The Texas Health and Human… Continue reading Texas Medicaid Updates Billing Process for UnitedHealthcare Community Plan
Colorado Medicaid Introduces New Prior Authorization Rules for Behavioral Health Services
From July 1, 2025, Rocky Mountain Health Plans plans to update the prior authorization procedures for a few of the CPT® codes when it is the primary payer. The chart inside this update lists the new CPT codes and their connections to prior authorization and notification requirements. These updates affect the following Rocky Mountain Health… Continue reading Colorado Medicaid Introduces New Prior Authorization Rules for Behavioral Health Services
Keep Your New York Medicaid Enrollment Active by Updating MPP or CAQH Profiles
All UnitedHealthcare Community Plan of New York contracted providers are reminded to ensure their practice data is accurate and current. This includes verifying and changing the office address, list of services, and whether to accept new patients. Maintaining correct data allows members to get the care they want with ease. Every 90 days, UnitedHealthcare asks… Continue reading Keep Your New York Medicaid Enrollment Active by Updating MPP or CAQH Profiles
Kansas and Nebraska Medicaid Will Only Accept Digital Claim Documents
Starting June 13, 2025, UnitedHealthcare will send fewer claim-related paper documents to most providers and facilities serving people with Medicaid in Kansas and Nebraska. As part of an effort to fast-track document access, providers in the UnitedHealthcare Community Plan will now experience this change. Provider remittance advice, prior authorizations, overpayment requests, appeal decisions, and most… Continue reading Kansas and Nebraska Medicaid Will Only Accept Digital Claim Documents
Maryland Medicaid Now Requires a Separate NPI for Every Practice Location
To enhance provider enrollment efficiency and minimize claim denials, Maryland Medicaid is introducing a policy mandating unique National Provider Identifier (NPI) numbers for each practice location. This change complies with Centers for Medicare & Medicaid Services (CMS) standards and aims to synchronize our billing and enrollment systems. Full details are available in Section 7 of… Continue reading Maryland Medicaid Now Requires a Separate NPI for Every Practice Location
Complete the C-SNP Patient Verification Form to Avoid Coverage Disruption
To enroll in a UnitedHealthcare Chronic Special Needs Plan (C-SNP), Medicare beneficiaries must meet specific health criteria. CMS mandates confirmation from a treating provider that the applicant is diagnosed with at least one of the plan’s three qualifying chronic conditions. Diabetes mellitus (pre-diabetic conditions are not considered eligible) Cardiovascular diseases, including heart rhythm abnormalities, coronary… Continue reading Complete the C-SNP Patient Verification Form to Avoid Coverage Disruption
New Prior Authorization Rules for Outpatient Therapy and Chiropractic Services
Prior authorization is now required for physical, occupational, speech therapy, and chiropractic care provided in offices or outpatient hospital settings. This applies to UnitedHealthcare® Medicare Advantage members. Home-based services are not included. What’s New? Providers must obtain prior authorization for PT, OT, ST, and Medicare-covered chiropractic services for UnitedHealthcare Medicare Advantage members. This applies to… Continue reading New Prior Authorization Rules for Outpatient Therapy and Chiropractic Services
CMS Proposes 2026 Updates for Psychiatric Facility Payments and Quality Rules
CMS published its proposed rule for the 2026 fiscal year IPF regulations on April 11, 2025. The proposed rule of 2026 introduces updated Medicare pay rates and facility-based adjustments with new quality reporting standards and a feedback request from the public. CMS proposes to increase IPF payment rates by 2.4 percent starting from FY 2026.… Continue reading CMS Proposes 2026 Updates for Psychiatric Facility Payments and Quality Rules
