June monthly overview

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

June 1 publication

Policy and protocol updates

Medical policy updates
Medical policy updates for June 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.

State news

Colorado: New behavioral health prior authorization and notification requirements
On July 1, new behavioral health prior authorization requirements will apply to certain services.

Help patients with serious mental illness get the care they need 
Learn about specialty plans that help Florida UHC Community Plan members with serious mental illness get the care they need.

Aug. 1: Electronic reconsideration and appeal submissions required
Health care professionals must submit Medicaid medical reconsiderations and appeals electronically in Kansas and Maryland.

Maryland Medicaid: Unique NPI numbers required for each practice location
Maryland Medicaid policy requires unique NPI numbers for each practice location to simplify enrollment, reduce claim errors

Sept. 1: Submit reconsiderations and appeals electronically for Nebraska Medicaid
Health care professionals are encouraged to submit Medicaid medical reconsiderations and appeals electronically in Nebraska

New Jersey Medicaid: Provision request is required for some DME prior authorizations
You’ll need to request an exceptional circumstances provision when submitting prior authorizations for durable medical equipment.

New York Medicaid: Update your data in My Practice Profile or CAQH
Help patients and other health care professionals find your practice faster by updating your demographic data.

UnitedHealthcare Community Plan of Texas: New Medicaid billing process
Changes include fee-for-service to managed care billing and how wraparound medications are reimbursed.

Fee source update

CMS 1500 alternate fee source update
On July 1, 2025, the existing alternate fee source from RJ Health will be updated to include Wholesale Acquisition Cost.

Medicare health plan

Outpatient therapies prior authorization program for Medicare Advantage expanding to Arizona, Colorado and Oklahoma
The prior authorization requirement for outpatient PT, OT, ST and traditional Medicare chiropractic services is expanding to specific plan members in Arizona, Colorado and Oklahoma July 1.

Complete verification form for C-SNP enrolled patients
Learn about the enrollment and verification process for UnitedHealthcare Chronic Special Needs Plans (C-SNP).

Steqeyma and Yesintek biosimilars to replace Stelara for Medicare Part D plans
As of June 1, 2025, Stelara will be replaced by 2 interchangeable biosimilar products for Medicare Part D plans.

The AARP Healthcare Options Provider website has moved
Use the UHC Provider Portal to access AARP Medicare Supplement insured members’ data. 

Code changes

Prior authorization needed for new genetic testing codes
On Sept. 1, we’ll require prior authorizations for certain genetic and molecular testing services.

Explore the CPT codes that need DEX Z-Codes
Review the CPT codes that require a DEX Z-Code as of April 1.

Digital tools and resources

Automate your workflow and save time with our APIs
Learn how APIs can help you streamline your workflow to save time and focus more on patient care. 

Get SDOH screening aids and resources in one place
Learn how to easily share screening results and access SDOH tools, resources and training to better support your patients.

Announcements