New codes that have been identified for 2020 will be accepted into the UCare system as of the effective dates but are subject to the editing update and implementation dates. Please allow time for the updates to be put into production to avoid resubmissions/ adjustments/incorrect editing of the claims.
To ensure access to benefits and services on Jan. 1, 2020, UCare has sent all impacted members a letter with their new 2020 member ID. Please accept this letter as proof of coverage until the new member ID cards arrive.
UCare has updated the following chapters of the Provider Manual: Working with UCare, Sales & Marketing by Providers, Provider Credentialing, Behavioral Health and Nursing Facility Services. Specific updates are called out in the Appendix.
Effective Jan. 1, 2020, UCare will make changes that affect claims submission and edits for all UCare Medicare and State Public Program plans. UCare will be adding a higher SNIP level to inbound claims submission for these plans in 2020.
UCare is continuing to implement our new claims syste. Effecitve Jan. 1, 2020, UCare will make changes that affect claims submissions for UCare Medicare Plans that include a new Payor ID for 2020 claims and new Member ID and format.
UCare informs providers of critical business reminders for the Credentialing and Recredentialing Process, Pharmacy, Complex Case Management Process, Utilization Management Information, Member Rights and Responsibilities, Shared Decision Making and Clinical Practice Guidelines.
Effective Jan. 1, 2020, the amount of the tax imposed on health care providers under Minn. Stat. § 295.52 (known as the “MinnesotaCare Tax”) is changing from 2% to 1.8% of gross revenues. As a result, the portion of provider reimbursement that represents payment by UCare for providers’ MinnesotaCare Tax expense will be adjusted accordingly, as applicable, effective for dates of service beginning Jan. 1, 2020.
Effective Jan. 1, 2020, providers billing Medicare Certified Home Health Care or End-Stage Renal Disease (ESRD) services to UCare must submit claims in accordance with Centers for Medicare & Medicaid Services (CMS) billing guidelines, including all required claim elements.
Beginning Jan. 1, 2020, Care Continuum, a subsidiary of Express Scripts, will be performing Medical Benefit Drug Prior Authorization reviews for all of UCare’s lines of business. Learn about how to initiate prior authorization requests with Care Continuum, which medical drugs requiring prior authorization and additional changes for 2020 and Biosimilar step therapy for medical drugs in 2020.
UCare's 2020 medical services and behavioral health authorization and notification requirements are now available on ucare.org/providers, under the Eligibility & Authorization section, including State and Public Programs, UCare Medicare Plans and UCare Medicare Plans with M Health Fairview & North Memorial, EssentiaCare and UCare Individual & Family Plan and UCare Individual & Family Plan and M Health Fairview.
The 2020 UCare pharmacy formulary changes are now available on the ucare.org/providers website. From the Pharmacy page, you can find the 2019 and 2020 formularies for each health plan. Also covered is a $25 copay cap for each covered insulin prescription filled for UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview with a list of covered formulary insulin and a summary of formulary changes for Medicare and Individual & Family Plans.
Read the 2020 Formulary Changes bulletin .
Effective Jan. 1, 2020, for all UCare State Plans, UCare will implement Minnesota Department of Human Services (DHS) billing requirements and reimbursement guidelines for off-campus provider-based hospital department services. The Modifier -PO or -PN is now a requirement for all UCare Plans.
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