Welcome UCare Providers
Newsletters & Alerts
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.
February 2020 Health Lines
See the February 2020 Health Lines.
Code and Editing Updates
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.
Potential Delay in Issuance of Some 2020 UCare Medicare ID Cards
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 Announces Changes Affecting Claims Editing for UCare Medicare and State Public Program Plans in 2020
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 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.
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.
Providers Asked to Verify That They are Using Correct Payor ID for 2019 and 2020 Medicare Claims
On Jan. 1, 2020, UCare changed the Payor ID to 55413 for UCare Medicare Plans, EssentiaCare and UCare Medicare with M Health Fairview & North Memorial claims submissions for 2020 dates of service. Please be aware that 2019 claims still need to be submitted under the old Payor ID 52629.
Read the February Bulletin for additional guidance.
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Rate Updates (CAH, RHC, FQHC): RateLetters@UCare.org
Updated February 2020
Region |
UCare Product |
Eligibility |
Service Area |
Narrow network? |
| North | UCare Medicare Plans (HMO-POS) |
Must have Medicare Part A & Part B to enroll Do not have end-stage renal disease |
Aitkin, Becker, Beltrami, Carlton, Cass, Clay, Clearwater, Cook, Crow Wing, Douglas, Grant, Hubbard, Itasca, Kanabec, Kittson, Koochiching, Lake, Lake of the Woods, Mahnomen, Marshall, Morrison, Norman, Otter Tail, Pennington, Pine, Polk, Red Lake, Roseau, St. Louis, Todd, Wadena, Wilkin | All UCare network providers |
| North | UCare Medicare Plans (HMO-POS) |
Must have Medicare Part A & Part B Do not have end-stage renal disease |
Aitkin, Becker, Carlton, Cass, Clay, Cook, Crow Wing, Hubbard, Kanabec, Lake, Morrison, Pine and St. Louis | All UCare network providers |
| Metro | UCare Medicare Plans (HMO-POS) |
Must have Medicare Part A & Part B Do not have end-stage renal disease |
Anoka, Benton, Carver, Chisago, Dakota, Hennepin, Isanti, Mille Lacs, Ramsey, Scott, Sherburne, Stearns, Washington, Wright | All UCare network providers |
| South | UCare Medicare Plans (HMO-POS) |
Have Medicare Part A & Part B Do not have end-stage renal disease |
Big Stone, Blue Earth, Brown, Chippewa, Cottonwood, Dodge, Faribault, Fillmore, Freeborn, Goodhue, Houston, Jackson, Kandiyohi, Lac qui Parle, Le Sueur, Lincoln, Lyon, Martin, McLeod, Meeker, Mower, Murray, Nicollet, Nobles, Olmsted, Pipestone, Pope, Redwood, Renville, Rice, Rock, Sibley, Steele, Stevens, Swift, Traverse, Wabasha, Waseca, Watonwan, Winona, Yellow Medicine | All UCare network providers |
| South | UCare Medicare Plans (HMO-POS) |
Have Medicare Part A & Part B Do not have end-stage renal disease |
Blue Earth, Dodge, Faribault, Fillmore, Freeborn, Goodhue, Houston, Le Sueur, Mower, Nicollet, Olmsted, Rice, Steele, Wabasha, Waseca, Watonwan, Winona | All UCare network providers |
In-Network Services |
|||||||
|---|---|---|---|---|---|---|---|
| Primary Care Office Visits | $0 copay | $25 copay | $0 copay | $20 copay | $0 copay | $0 copay | $0 copay |
| Specialist Office Visits | $35 copay | $50 copay | $20 copay | $45 copay | $40 copay | $10 copay | $35 copay |
| Inpatient Hospital Care | $400 copay per stay (not per day), then 100% coverage, unlimited days per admission | $300 copay per day (days 1 - 5), then 100% coverage, unlimited days per admission | $250 copay per stay (not per day), then 100% coverage, unlimited days per admission | $300 copay per day (days 1 - 5), then 100% coverage, unlimited days per admission | $500 copay per day (days 1 - 3), then 100% coverage, unlimited days per admission | $100 copay per stay (not per day), then 100% coverage, unlimited days per admission | $150 copay per day (days 1 - 5), then 100% coverage, unlimited days per admission |
| Urgent Care | $50 copay | $45 copay | $50 copay | $50 copay | $40 copay | $0 copay | $50 copay |
| Worldwide Emergency Care | $100 copay | $90 copay | $100 copay | $100 copay | $90 copay | $100 copay | $100 copay |
| Medicare Part D Prescription Drug Coverage* | No Prescription Drug Coverage | $400 deductible | Copays based on drug tiers | $200 deductible | Copays based on drug tiers | $400 deductible | Copays based on drug tiers | $400 deductible | Copays based on drug tiers | Copays based on drug tiers | $200 deductible | Copays based on drug tiers |
| Preventive Dental Coverage | Yes | No | Yes | Yes | Yes | No | No |
| Vision Coverage-Routine | Routine Eye Exam: 1 per year, $0 Copay | Routine Eye Exam: Not Covered | Routine Eye Exam: 1 per year, $0 Copay | Routine Eye Exam: 1 per year, $0 Copay | Routine Eye Exam: 1 per year, $0 Copay | Routine Eye Exam: 1 per year, $0 Copay | Routine Eye Exam: 1 per year, $0 Copay |
| Vision Coverage-Diagnostic | Diagnostic Eye Exam: $35 copay | Diagnostic Eye Exam: $50 copay | Diagnostic Eye Exam: $20 copay | Diagnostic Eye Exam: $45 copay | Diagnostic Eye Exam: $40 copay | Diagnostic Eye Exam: $10 copay | Diagnostic Eye Exam: $35 copay |
| Hearing Services-Routine | Routine Hearing Exam: 1 per year, $0 Copay | Routine Hearing Exam: Not Covered | Routine Hearing Exam: 1 per year, $0 Copay | Routine Hearing Exam: 1 per year, $0 Copay | Routine Hearing Exam: 1 per year, $0 Copay | Routine Hearing Exam: 1 per year, $0 Copay; $500 allowed every 36 months for hearing aids | Routine Hearing Exam: 1 per year, $0 Copay |
| Hearing Services-Diagnostic | Diagnostic Hearing Exam: $35 copay | Diagnostic Hearing Exam: $50 copay | Diagnostic Hearing Exam: $20 copay | Diagnostic Hearing Exam: $45 copay | Diagnostic Hearing Exam: $40 copay | Diagnostic Hearing Exam: $10 copay | Diagnostic Hearing Exam: $35 copay |
| Out of Pocket Maximum | $3,400 | $5,000 | $3,400 | $3,400 | $4,500 | $3,000 | $3,000 |
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Benefit and cost share information for UCare Medicare Plans
* Part D deductible only applies to some drugs. See the Drug Formulary for details.
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