Things You Should Know This Week

UnitedHealth Group has announced two important policy updates:

1. Medicaid Therapy Services (KS, NC, VA)

Updates have been released regarding therapy service requirements under Medicaid programs in Kansas, North Carolina, and Virginia. Effective Nov. 1, 2025, UnitedHealthcare will require health care providers to obtain prior authorization for physical therapy (PT), occupational therapy (OT) and speech therapy (ST) services for UnitedHealthcare Community Plan members. Read more here: https://www.uhcprovider.com/en/resource-library/news/2025/ks-nc-va-medicaid-therapy-services.html?cid=em-providernews-2025nnb2-sep25

2. Medicare Advantage Claims Processing Issue

UHC identified a processing issue (that we already knew about but apparently they're just identifying ) that may have caused denials for lack of prior authorization for Medicare Advantage members within their first 90 days of enrollment, even when they were already undergoing an active course of treatment.

Impacted dates of service: July 1, 2024 – June 30, 2025

Action: Denied claims during this timeframe may be resubmitted with documentation of active treatment during the first 90 days.