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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

Healthcare providers can access free training materials through Optum that explain how to merge behavioral health services with primary care practice. The training platform operates on demand while focusing on improving healthcare results and community wellness. The Behavioral Health Identification Treatment and Referral in Primary Care series provides education to a broad spectrum of healthcare… Continue reading Free Training to Help Providers Integrate Behavioral Health

In Florida, UnitedHealthcare introduced extended Community Plan benefits to enhance both patient access to care and health outcomes for members. These updated changes focus on making care plans more accessible for patients and offering doctors new tools to treat their patients effectively. The recent changes in benefits allow members to access a monthly payment of… Continue reading UHC Expands Benefits for Community Plan Members in Florida

To ensure UnitedHealthcare Community Plan of Kentucky members are assigned to the primary care provider (PCP) most involved in their care, UnitedHealthcare has updated its attribution process. Starting March 1, 2025, UnitedHealthcare will conduct quarterly reviews of claims from the past 24 months to check if a member is regularly seeing a non-assigned PCP. If… Continue reading Kentucky Medicaid: Updates to Primary Care Attribution You Should Know

Applies to CPT® codes 81422 and 81479 To meet state requirements, starting June 1, 2025, UnitedHealthcare Community Plan of Maryland requires prior authorization for two types of Non-Invasive Prenatal Testing (NIPT) for its members. This applies to CPT codes 81422 and 81479 when used for: NIPT for trisomy screening and sex chromosomal analysis. NIPT for… Continue reading Maryland Medicaid Now Requires Prior Auth for Select NIPT Tests

For UnitedHealthcare Individual Exchange plans (also called Individual & Family ACA Marketplace plans), prior authorization is required for total joint replacement procedures. Providers requesting these procedures (CPT codes 27445, 27447, 27130, and 27132) due to osteoarthritis may need to submit additional medical documentation. This applies nationwide, and no new codes are being added to the… Continue reading New IFP Rule: Now Requires Medical Records for All Hip and Knee Surgeries

The Ohio Department of Medicaid website provides guides, past webinars, and answers to frequently asked questions regarding the EVV system for providers to access. Current preparations by healthcare providers will help prevent future claim problems while maintaining compliance with state and federal requirements. UnitedHealthcare introduced electronic submission of unsolicited claim attachments as a new business… Continue reading UnitedHealthcare Expands EDI 275 Claim Attachment Options

UnitedHealthcare Community Plan requires all Ohio home health providers who work with them to establish EVV system access through Sandata beginning June 1, 2025. The state-wide implementation supports the 21st Century Cures Act by working to enhance home- and community-based service quality through increased accountability. Home health providers risk denial of claims for their home… Continue reading Ohio Providers Must Use EVV Platform to Avoid Claim Denials for Home Health Services

UnitedHealthcare Community Plan in New York adjusted the process of getting referrals for Medicaid beneficiaries under its system. It works towards simplifying patient care access while minimizing administrative work for health providers. Specialty services now require no referral from primary care providers for their main condition for care. Most UnitedHealthcare Community Plan New York Medicaid… Continue reading UnitedHealthcare Updates Referral Policy for New York Medicaid Members

The Centers for Medicare and Medicaid Services (CMS), through their official announcement on April 17, 2025, extended the necessary off-cycle revalidation deadline for skilled nursing facilities (SNFs). The revised deadline demands SNFs to finish their revalidations together with an updated Attachment 1 instead of Form 855A Sections 5 and 6 before August 1, 2025, while… Continue reading CMS Extends SNF Off-Cycle Revalidation Deadline to August 1, 2025