Q4 Update to UCare's Provider Manual
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.
See the Q4 October 2019 Provider Manual
UCare’s “A Salute to Excellence!” Celebrates 22 Health Care Providers
UCare held its 11th annual "A Salute to Excellence!" event Thursday, Sept. 26, to honor 22 Minnesota clinics and care systems with top results in 2018 Healthcare Effectiveness Data and Information Set (HEDIS) measures
Read the Oct.16 bulletin
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CORRECTION: Coding Changes for Adults and Children's MH Crisis Response Services for UCare SPP Products
The October Health Lines informed providers that effective Nov. 1, 2019, UCare will require the services previously submitted with HCPCS S9484 to be submitted using HCPCS code H2011. There was an error in the billing grid that was included in the article. Community intervention services should still be submitted using HCPCS code 90882.
We apologize for any inconvenience this error may have caused.
See the Oct. 7 bulletin for the corrected billing grid
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November 2019 Health Lines
Learn about the 2020 Health Plan Benefits Summary, the new PAC Phone Message, Portal access to Medicare Part D Appeal and the Ineligible Provider List, CMS/DHS billing requirements for the 340B Drug Pricing Program, the Q4 Provider Manual Update, Documentation Improvement for Status Codes, November Cervial Screening Webinar, Annual Model of Care (MOC) Training and the PAC Holdiay Hours for Thanksgiving.
Read the November Health Lines.
UCare Announces Changes Affecting Claims Submissions for UCare Medicare Plans Beginning Jan. 1, 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.
See the full bulletin.
UCare to Suspend Authorizations in 2019 For UCare Individual & Family Plans
During 2019, UCare will temporarily suspend the requirement for prior authorizations for services delivered to members with UCare Individual & Family Plans and UCare Individual & Family Plans with Fairview.
See the full Provider Bulletin.
Critical Business Reminders
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.
See the July 30, 2019, Bulletin.
UCare Modifies Authorization Requirements for Children’s Therapeutic Services and Support Thresholds, Substance Use Disorder Inpatient Admission and Residential Treatment Services
UCare has updated its authorization requirements for CTSS thresholds and SUD inpatient admission and residential treatment services to align with DHS changes.
See the full Provider Bulletin.
MinnesotaCare Tax Changing Jan. 1, 2020
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.
Read the full bulletin.
Billing Requirements for Medicare Certified Home Health Care and ESRD Providers
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.
Read the full bulletin.
Hospital Interim Claims Billing
Final Bill for Long-term Hospitalization Includes Appropriate Bill Type
As a reminder, hospitals billing interim claims for long stay inpatient cases to UCare must submit services in accordance with Centers for Medicare & Medicaid Services (CMS) billing guidelines.
2020 Changes to Medical Benefit Drug Prior Authorizations
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.
Read the 2020 Drug PA Bulletin.
UCare's 2020 Authorization & Notification Grids
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.
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