UnitedHealthcare has issued new policy changes to Primary Care Providers (PCPs) in the Maryland HealthChoice Medicaid program. The changes will streamline provider duties and coordinate caring, so that members get timely and quality healthcare services.
PCP Assignment To Be Made Compulsory
According to HealthChoice program requirements, every member of the UnitedHealthcare Community Plan (Medicaid) should have a PCP. In case a member does not select it, a PCP will be given automatically. The provider assigned will be inscribed on the ID card of the member. Although the members can go to any PCP in the program, UnitedHealthcare will promote the utilization of the same provider to have a centralization of medical records and better care continuity.
Observation of Members and PCP Reassignment Support
The participating providers can treat any member of Medicaid, whether assigned a PCP or not. It is possible to check the eligibility using the Maryland EVS Portal or the UnitedHealthcare Provider Portal.
Members can also make a change to their assigned PCP by calling Member Services at 800-318-8821 (TTY 711), Monday-Friday, 8 a.m. 7 p.m. ET. The PCPs are advised to help the members through the process to ensure their records are updated and the correct provider is listed.
PCP Panel Management
Through UnitedHealthcare Provider Portal, the providers can access their member panel lists, adjust panel limits, and monitor HEDIScare gaps. Review of panels is done once a month to ensure effective management of the capacity of patients.
Specialist Referrals are Needed
It is the role of PCPs to refer to in-network specialists in case of any further care requirement. All specialist visits must be pre-planned to ensure that there is order in treatment pathways.
View the Maryland Provider Manual or contact 24/7 chat on the UnitedHealthcare Provider Portal for more details.
Healthcare providers who work with New Jersey Medicaid are now being asked to share how they use technology in their practice. This is part of a new rule that requires providers to report their technology use every three months.
UnitedHealthcare has started sending emails to providers. These emails will come from either provider_demographics@uhc.com or adobesign@adobesign.com.
How You Can Submit Information
The form includes questions regarding your practice’s experience or participation with:
In case of questions, contact your representative.
Yorvipath will require new prior authorization procedures, which will start on September 1, 2025, and Zoryve will have an additional check on plaque psoriasis included in clinical criteria.
It is advised that providers take another look at the updated criteria and make sure that they comply by the effective date.
The official documentation can be used to have full details
In case of questions or further help, you can chat on UnitedHealthcare Provider Portal.
UnitedHealthcare has stated, it will provide coverage for in vitro fertilization (IVF) and infertility and fertility services on some of its California commercial plans before a requirement outlined in Senate Bill 729 (SB 729) takes effect on January 1, 2026.
Effective as of July 1, 2025, SB 729 has been delayed and will resume on Jan. 1, 2026. Nonetheless, UnitedHealthcare will continue to provide coverage on such services to the exclusion of their waiting period in California as a standard benefit to its new and renewed insured large employer groups' policies between July 1 and Dec. 31, 2025.
Starting on Jan. 1, 2026, infertility and fertility services coverage will be required in all large-group health plans and those issued outside of California, as well as in all small-group health plans and disability policies that choose to cover the services. Covered services apply to diagnosis and treatment of infertility, artificial insemination, and assisted reproductive technologies, including but not limited to IVF. The number of oocyte retrievals is up to three; there are no limits to the number of transfers to embryos per plan year.
Notably, it also covers the services of an egg and sperm donor, surrogates, and does not have limitations in coverage for medical and disability plans, ending the exclusion of LGBTQ+ people in fertility coverage.
Although prior authorization is still obligatory, providers may use the UnitedHealthcare Provider Portal to make requests. To get clinical assistance and medical guidance, members have access to contacting Optum Fertility Solutions at 866-774-4626. Claims will be met even when Optum Fertility Solutions is not utilized.
In case of questions or further help, you can chat on UnitedHealthcare Provider Portal.
FDA recently authorized self-collected high-risk human papillomavirus (hrHPV) testing in a medical facility for routine cervical cancer screening (CCS). This important update is for women’s health. It is not for patients who have symptoms or need follow-up testing after abnormal results.
This self-collection option approved by the FDA offers a helpful solution for patients who are unable to have a cervical sample collected in the usual way.
Who Can Use the New Test
Testing and Coding Information
Understanding the Test Results
If you have more questions, then chat 24/7 in the UnitedHealthcare Provider Portal
Under your contract and California Senate Bill 137, you must review and update your demographic details, such as office location, phone number, and hours. If the information is incorrect, your details will be removed from the provider directory.
Here’s How to Check and Update Your Demographic Information
CAQH
My Practice Profile
UnitedHealthcare Demographic Change Request Form
Not updating your information may delay payments or claim reimbursements per California Health & Safety Code Section 1367.27(p).
Why It’s Important
Accurate data helps members find you based on:
Some members also consider your cultural competencies, like:
Questions?
Providers can chat with UnitedHealthcare or visit the support resources for assistance.
TMHP and HHSC have provided a prolonged time to revalidation and enrollment gap flexibilities until November 30, 2025, allowing providers time to remain active. Providers that have initiated revalidation or reenrollment should complete the applications and resolve any barriers as soon as possible to avoid gaps in service.
Providers that have not initiated the revalidation process ought to start immediately. Revalidation can be initiated up to 180 calendar days prior to the provider’s due date.
Effective July 8, 2025, the Texas Health and Human Services Commission (HHSC) is offering additional flexibility to providers who have already been granted a 180-day revalidation due date extension. If these providers are unable to complete their revalidation by the updated due date, they may qualify for a second 180-day extension.
This new extension will automatically appear in the Provider Enrollment and Management System (PEMS) under the Provider Information section.
Revalidation Deadline Extensions
Providers whose revalidation due dates fall between December 13, 2024, and November 30, 2025, will automatically be given an additional 180 days to undertake the process. The PEMS system checks daily for providers with revalidations due the next day. If the revalidation isn’t completed, the system will automatically add 180 calendar days to the current due date. This new extension is on top of any previous extensions already given.
Note: PEMS is giving first-time extensions to eligible providers daily. Starting July 8, 2025, PEMS will also offer second extensions to providers who got an earlier extension but haven’t finished revalidation.
Providers who have already received a 180-day extension and have a revalidation due date between June 1 and July 7, 2025, might get a disenrollment letter before the extension appears in PEMS. Once PEMS is updated, any providers who were disenrolled for not revalidating will be reactivated, and TMHP will reprocess any affected claims.
Starting July 8, 2025, the Revalidation Due Dates section on the Provider Information page in PEMS will show the updated extension. Providers will also get a confirmation letter by mail and an email notification with the new due date. This extra time will help providers finish and submit their PEMS revalidation and avoid disenrollment.
Important Reminder
A provider’s revalidation is only complete when the request status shows “Closed-Enrolled.” Submitting the request is just the first step. TMHP will review the request, and it must be approved before it can reach the “Closed-Enrolled” status.
For help with revalidation or reenrollment, providers can visit the Provider Enrollment Help page or the PEMS Instructional Site on tmhp.com.
Starting October 3, 2025, appeal letters, claim letters, and virtual card payment (VCP) statements will no longer be mailed. These documents will be available to view and submit anytime through the UnitedHealthcare Provider Portal.
You’ll also need to send claim reconsiderations and medical appeals (both before and after services) online.
Such modifications will affect the majority of the medical providers and facilities (primary and support) that serve members of UnitedHealthcare Community Plan (Medicaid) in Hawaii.
In case you have a third-party vendor, such as a billing company, be sure that they are aware of these new digital processes.
How to view your claim letters and documents
You can find your letters and documents anytime in the Document Library on the UnitedHealthcare Provider Portal. They’re stored securely for up to 24 months.
Here’s how to access them:
Choose a folder:
Email Notifications:
Tip: Don’t wait for alerts — check the Document Library regularly for new letters or needed actions.
You can also visit the Profile & Settings Overview to learn how to update email notifications.
Explore Document Library
How to submit a pre-service appeal
You can submit a pre-service appeal using the Prior Authorization and Notification tool in the UnitedHealthcare Provider Portal.
Follow these steps:
Tip: Use Advanced Filter in the Document Library to find your pre-service appeal decision letters.
Submitting Claim Reconsiderations and Post-Service Appeals
Providers can submit claim reconsiderations and post-service appeals through the UnitedHealthcare Provider Portal by following these steps:
Need Help?
Providers can use 24/7 live chat in the UnitedHealthcare Provider Portal to connect with support. For help with portal access, technical problems, or notification settings, call UnitedHealthcare Web Support at 866-842-3278 (option 1), Monday–Friday, 7 a.m.–9 p.m. CT.
Effective July 1, 2025, prior authorization will be required when healthcare providers in Texas want to prescribe axatilimab-csfr (Niktimvo) to Medicaid patients as well. Niktimvo is an IV drug that treats individuals with chronic graft-versus-host disease (cGVHD), a disease that may develop following a stem cell transplant.
Patients will have to fulfill a number of conditions in order to secure the approval of this drug. They are required to weigh at least 88 pounds and must have a diagnosed cGVHD in a particular medical code (D89811 or D89812). The patient should have received an allogenic stem cell transplant and failed to respond to two other treatments. Also, physicians should ensure that they have discussed birth control with any female patient who is capable of becoming pregnant because one should not get pregnant during the treatment or 30 days after treatment.
The same holds in the case of patients who are already taking Niktimvo and require further therapy. The patient should also be doing well on the drug without having severe side effects and demonstrate an improvement.
Doctors are also expected to keep a close watch on the patients. The liver enzymes and other blood markers such as AST, ALT, ALP, CPK, amylase, and lipase should be tested prior to treatment, after every two weeks in the first month, and a month or two following completion of treatment.
Effective July 15, 2025, UnitedHealthcare will implement a 15 percent payment cut on services furnished by selected Advanced Practice Health Care Practitioners as part of the unit's Medicare Advantage plans, as well as Dual Complete plans. The change corresponds to the recommendations of the Centers for Medicare and Medicaid Services (CMS).
The cut will be in place on claims whose listed provider is a Physician Assistant (PA), Nurse Practitioner (NP), or Clinical Nurse Specialist (CNS) and/or where a separately contracted non-physician fee schedule is not in place. This update is aimed at aligning the payment practices of UnitedHealthcare with national standards of Medicare.
Some exceptions are quite important. The reduction of 15 percent will be excluded in case of a billing through the SA modifier, indicating that the concerned provider worked together with a physician. The same applies to services that are compliant with the incident-to billing regulations of CMS. This implies that such service was provided directly under the physician's supervision and charged under the National Provider Identifier (NPI) of the physician.
It is recommended that healthcare providers observe the correct billing to prevent inaccurate payments. This involves the right code and ensuring that the documentation is to substantiate the services charged.
For billing or any questions, the providers can also access the UnitedHealthcare Provider Portal, which provides chat support 24/7.
This is one of the ways that UnitedHealthcare is trying to increase the accuracy of billing and adherence to CMS payment policies. The providers will do well to act early to audit their billing practice and get into compliance by the July 15 deadline.
