Medical Policy Update Bulletins: May 2026 | Access a policy for complete details on the latest updates. A comprehensive summary of changes is provided at the bottom of every policy document for your reference. Intended: Admissions; Medical Management; Patient Access; Physicians; Prior Auth |
Reimbursement Policy Update Bulletins: May 2026 | Review the details on reimbursement policy updates through the links. - The United Community Plan has a “Diagnosis Code Requirement Policy, Professional and Facility” for Texas that is effective 6/1/26
Intended: Coding; CBOs, Physicians |
| Specialty Medical Injectable Drug Program updates: May 2026 | You can access the Medical Benefit Specialty Drug Update Bulletin for the latest updates on drugs added to review at launch, program requirements, and policies. Intended: Pharmacy; Physicians |
Pharmacy and clinical updates: May 2026 | Access the drug list and pharmacy updates here. Intended: Medical Management; Pharmacy; Physicians |
State News: | STAR Kids members may be allotted 8 hours of supervised care in an in-network prescribed pediatric care center (PPECC) during normal business hours and if the member meets the following criteria: - Have PPECC or private duty nursing (PDN) services as a benefit in their health plan
- Live in one of the following service areas: Harris, Jefferson, Hidalgo, Managed Care Service Area (MRSA) Central or MRSA Northeast
Intended: Patient Access, Physicians, Prior Auth |
Health Plan Updates: | Community Plan of Rhode Island: Brown University Health remains in Network - Does not apply to Texas
- View article for more details
Medicare AL, AR & SC: Synapse Health will soon manage DME orders - Does not apply to Texas
- View article for more details
Intended: Patient Access, Physicians, Prior Auth |
Oncology News: | New oncology prior authorization code required - To comply with CMS and/or American medical Association procedure code updates, effective Oct 1, 2026, prior authorization will be needed for the following HCPCS code when administered in outpatient settings as treatment for cancer diagnosis:
HCPCS Code: J2860
Description: Injection, siltuximab, 10mg - View the article for more details
Certain oncology medications added to Site of Care Policy - Beginning Aug 1, 2026,UHC will add select oncology medications, which are used in maintenance therapy or monotherapy, to the Provider Administered Site of Care Policy. The expansion of this policy is to ensure members have access to clinically safe, quality care for injectable medications at the site of care that is most appropriate to meet their needs.
- These medications already require prior auth for medical necessity, and the site of care review will be included in the prior auth process. This update applies to UHC commercial plans, including Fully Insured, Level Funded and ASO plans.
- View Medical policy Bulletin: May 2026 for more details
Intended: Patient Access, Physicians, Prior Auth |
Quality Improvement: | 2025 Quality Improvement survey results - Annual surveys are conducted as a part of the Quality Improvement (QI) program to better understand the experiences of members and the health care professionals who serve them. The following information outlines the 2025 survey results.
- View article for more details
Intended: Patient Access, Physicians, |
Training: | Honor AAPI Heritage Month with health equity training - May is Asian American and Pacific Islander (AAPI) Heritage Month, a time to recognize the unique factors that influence health outcomes across AAPI communities. Understanding these factors can help identify barriers to care and tailor communications, care plans, and follow-up visits to better support patients.
- View article for more details
Intended: CBOs, Patient Access, Physicians, Prior Auth |
