Starting August 1, 2024, it will be easier for LTSS providers to get extra payment. Providers contracted with UnitedHealthcare Community Plan of Texas just need to enroll in the ACEP program to receive higher rates when submitting claims. Enrollment with HHSC is no longer required first.
New this year
In the past, all LTSS providers had to join ACEP through HHSC. Now, only providers with a fee-for-service contract with Texas HHS need to enroll.
How to enroll
Complete the UnitedHealthcare ACEP form online no later than 5 p.m. on Oct. 01, 2024, to receive the increased payment rate of SFY 2025. You should do this annually during the enrollment period to maintain the improved rate.
What you need to know
ACEP is specifically for providers with STAR+PLUS and UnitedHealthcare Connected (Medicare-Medicaid Program).
When you enroll, they’ll pay you the higher rate for claims starting from September 1, 2024.
If this is your first time enrolling, they’ll mail you a Participation Agreement. Just sign it and send it back. They’ll start paying the higher rate once it’s processed.
Make sure to use your enhanced rate when submitting claims.
Resources
Visit the Texas HHS website and check the 2025 Rate Enhancement Attendant Compensation Information page for a full overview of the program.
Questions?
For additional information, contact your provider advocate. Send an email to uhc_cp_prov_relations@uhc.com or call 888-787-4107.
UnitedHealthcare Community Plan members in Pennsylvania will not pay copays on medical or pharmacy services, starting July 1, 2025. The change will affect every service provided under the Medicaid coverage.
Get Answers
Providers must refer to the UnitedHealthcare Provider Portal to verify eligibility or details of the patient. New subscribers are able to register online quickly. You can find 24/7 help via the live chat support of the portal.
The following is a reminder to health care providers in STAR+PLUS and the UnitedHealthcare Connected Medicare-Medicaid Program who want to receive the increased payment rates during the upcoming fiscal year to enroll in the Attendant Compensation Enhancement Program (ACEP) by contracting with long term services and supports (LTSS) providers under the STAR+PLUS and the UnitedHealthcare Connected Medicare-Medicaid Program.
ACEP is provided by the Texas Health and Human Services Commission in order to help provide higher wages to attendants providing the critical LTSS services. To claim the higher rate on claims with a date of September 1, 2025, to August 31, 2026, the provider should enroll in that program by the deadline of July 31, 2025, 5 p.m. CT.
ACEP is not an automatic organization to join. All providers should fill in the enrollment form every year, regardless of their current status, to be eligible. This concerns returning as well as new enrollees.
The form will automatically enroll already existing ACEP participants once the form has been completed and verified. The individuals who do not fill in the form on time risk being excluded from the program as of September 1, 2025.
New participants (those who have not yet participated) will be sent a Participation Agreement by mail once the form has been submitted. The new rate will come into effect starting September 1, 2025, after being signed and processed. They also ask providers to make claims using the new rate once the enrollment is completed.
Those providers will find detailed information regarding ACEP on the Texas HHSC site at 2025 Rate Enhancement Attendant Compensation Information.
Health care providers enrolled in the Arizona Vaccines for Children (VFC) program must be re-enrolled annually and should be re-enrolled by August 31, 2025. A failure to do this can mean being dropped from the VFC program and inactivation of members under 18 years of age in provider panels. Providers are encouraged to complete the re-enrollment process to continue qualifying and avert service interruption. Clear guidelines can be obtained in the Arizona VFC Re-enrollment Provider Guide. To receive help and re-enroll on the Internet, please visit asiis.azdhs.gov. Support can be received to continue participating in the program and taking care of the patients.
UnitedHealthcare has recently informed about the changes it will make to genetic and molecular testing coverages, as well as prior authorization policies starting January 1, 2025. Such changes will affect some UnitedHealthcare commercial plans and all UnitedHealthcare Exchange plans.
In the upgrade, UnitedHealthcare will allow coverage on some codes and eliminate prior authorization on some multi-panel pharmacogenetic testing procedures.
Affected UnitedHealthcare Plans Include:
Procedure Codes No Longer Requiring Prior Authorization:
For more information or to register for training, providers can visit the Genetic and Molecular Testing Prior Authorization/Advance Notification Program website.
Effective June 1, 2025, health care providers in Nebraska must be enrolled with the State of Nebraska to be Medicaid reimbursed. This policy modification is in line with Title 471 of the Nebraska Medical Assistance Program Services, and it applies to all providers billing the UnitedHealthcare Community Plan of Nebraska Medicaid members.
Claims that are filed by providers who are not appropriately enrolled with the state will be denied under the new requirement. All providers are required to have an active National Provider Identifier (NPI), and each location where the business provides service is registered in the state to be eligible to obtain reimbursement.
Updates and enrollment requirements should be made by using the Nebraska Provider Data Management System (PDMS) that is maintained by Maximus. They are enabled to make either a new account or revise an agreement online by the providers. The new rules do not accept paper-based applications anymore.
Providers who want to have a retroactive start date to their enrollment should put this request in their online application. The home- and community-based services (HCBS) providers, however, cannot receive retroactive effective dates.
This enforcement is consistent with the actions of Nebraska to enhance program integrity and proper oversight of services under Medicaid across the state.
The providers are urged to enroll as fast as possible to prevent any form of interruption in the processing of claims and the delay of payments. All the details and enrollment procedures are provided on the Nebraska Medicaid Provider Screening and Enrollment webpage.
This is an important update to all the Medicaid-serving providers to be able to continue service reimbursement under the Nebraska Medicaid program.
Note: A Texas Medicaid managed care organization (MCO) shall provide any medically necessary and Medicaid-covered services to the members who have enrolled in their MCO. Administrative procedures such as prior authorization, precertification, referrals, as well as claiming and filing of encounter data, may be very different not only from traditional Medicaid (fee-for-service) but from one MCO to another. Providers must, therefore, contact the particular MCO of the member for further details.
The Texas Medicaid & Healthcare Partnership (TMHP) discovered a problem with the static fee schedule update processed on April 15, 2025, where the Clinical Laboratory static fee schedule (PRCR494C) contained duplicate entries. TMHP has corrected the issue and will issue an off-cycle static fee schedule on June 16, 2025, including the revised Clinical Laboratory static fee schedule.
For additional details, contact the TMHP Contact Center at 800-925-9126.
Following the contract and California Senate Bill 137, the provider is required to verify and update their demographic data to ensure its accuracy. The demographic information includes the location of the office, phone number, hours of operation, and similar information. Should the data be inaccurate, the provider’s information will be removed from the provider directories.
How to verify your demographic data
CAQH
My Practice Profile
UnitedHealthcare Demographic Change Request Form
Failure to maintain updated directory information may lead to delays in payment or claim reimbursement, as outlined in California Health & Safety Code Section 1367.27(p).
Why It Matters
Accurate provider information helps members find and choose the right care. Most members base their decisions on:
Some members also consider cultural competencies, such as:
Need Help?
Providers can connect via chat or explore available support resources.
The Centers for Medicare & Medicaid Services (CMS) held an in-person listening session to discuss the recent release of the Health Technology Ecosystem Request for Information (RFI) and how to use the health technology innovations to improve patient care and create efficiencies in the healthcare ecosystem. The meeting convened stakeholders from across the healthcare ecosystem including patients, caregivers, technology companies, data providers, and networks; healthcare providers, value-based care organizations, and payers were provided the chance to share their experiences and best practices on using digital health technologies to curb fraud, reduce administrative burdens, and provide higher quality care for millions of beneficiaries.
At the meeting, CMS shared plans to start several projects to create the basic systems needed for a healthier healthcare system, which is in line with Secretary Kennedy’s goal to Make America Healthy Again. These projects include:
The initiatives, as well as the RFI, are mechanisms that CMS uses to update healthcare through digital health, data security, program integrity, and Medicare, Medicaid, and federal marketplace efficiencies. CMS is seeking comments on this RFI, which are due no later than June 16, 2025.
Starting September 1, 2025, UnitedHealthcare will partner with HearUSA to grow its network of hearing aid providers. This partnership will help better meet the hearing aid needs of UnitedHealthcare Community Plan of Texas (Medicaid) members.
The expanded provider network will be available to members in all Medicaid plans, including CHIP, STAR, STAR Kids, and STAR+PLUS.
How to find a network provider
Members can search for doctors, dentists, or other providers by visiting the Find a Provider page and selecting “Sign in to find a network provider.”
They can also reach out through 24/7 chat on the UnitedHealthcare Provider Portal or call Member Services at 888-887-9003.
Coverage with HearUSA
HearUSA providers offer support for monaural and binaural hearing aids, encompassing fitting, follow-up care, batteries, and repairs.
Please note: Surgically implanted hearing aid devices and services are provided by other suppliers.
Resources
For additional details, members and providers can refer to the hearing aid quick reference guide or the Texas UnitedHealthcare Community Plan Provider Manuals available on the UnitedHealthcare website.
Questions? Assistance is available.
For help, providers can contact their provider advocate or call Provider Services at 888-887-9003, Monday to Friday, from 8 a.m. to 6 p.m. CT.
