Clinical Practice Guidelines

UCare’s clinical practice guidelines includes the primary source with a direct link to online content, modifications (if needed) for our unique populations, rationale for modifications and additional references if available.

MEDICAL

UCare, through the Quality Improvement Advisory and Credentialing Committee (QIACC), adopts medical clinical practice guidelines from nationally or locally recognized sources. Sources may include medical specialty societies and other professional organizations. The guidelines are based on reasonable medical evidence or a consensus on clinical treatment patterns by physicians in the selected field of practice.

Asthma, Diagnosis and Management
Primary Source: Global Initiative for Asthma

Diabetes, Type 2; Diagnosis and Management
Primary Source: American Diabetes Association

Management of Heart Failure in Adults
Primary Source: Journal of the American College of Cardiology (JACC)

Obesity in Adults; Prevention and Management
Primary Source: American Academy of Family Physicians

Prenatal Care
Primary Source: American Academy of Family Physicians

Preventive Services for Adults
Primary Source: American Academy of Family Physicians

Preventive Services for Children and Adolescents  (Approval: December 19, 2019) 
Primary Source: American Academy of Pediatrics Bright Futures (AAP)

 

BEHAVIORAL HEALTH

UCare adopted five behavioral health clinical practice guidelines to support good decision-making by patients and clinicians, improve member health outcomes and meet NCQA accreditation standards. Adult guidelines are adopted from American Psychiatric Association (APA). Child and adolescent guidelines are adopted from the Journal of the American Academy of Child Adolescent Psychiatry. 

Assessment and Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder  (Approval: September 17, 2020)
Primary Source: American Academy of Child and Adolescent Psychiatry 

Assessment and Treatment of Children and Adolescents with Depressive Disorders  (Approval: September 17, 2020)
Primary Source: American Academy of Child and Adolescent Psychiatry 

Treatment of Patients with Major Depressive Disorder  (Approval: September 17, 2020)
Primary Source: American Psychiatric Association 

Treatment of Patients with Schizophrenia  (Approval: September 17, 2020)
Primary Source: American Psychiatric Association 

Treatment of Patients with Substance Use Disorders (SUD)  (Approval: September 17, 2020)
Primary Source: American Psychiatric Association

 

PHARMACY

UCare adopts the Minnesota Department of Human Services (DHS) Preferred Drug List guidelines to ensure a more consistent drug benefit for our Medicaid line of business. This clinical practice guideline is developed by Minnesota DHS Drug Formulary Committee.
 
 

UCare Implements New Transportation Management Software

UCare has rolled out a new transportation system to schedule rides for our members. The new service will continue to be called UCare HealthRide.

 

Read the June 22 Provider Bulletin.

 

 

 

 

 

As UCare implements the new claims system, you may have questions. Please see the most common questions below before contacting UCare for additional assistance. New questions will be added as they arise, so check back frequently.

Which Payor ID should be used for claims in 2019 vs. 2020?

The chart below indicates which Payor ID should be used for each UCare plan based on the claim date of service (DOS). The items in Red show which plans changed Payor IDs from 2019 to 2020:

Product

2019 DOS Payor ID

2020 DOS Payor ID
UCare Individual & Family Plans 55413 55413
UCare Individual & Family Plans with M Health Fairview 55413 55413
UCare Medicare Plans 52629 55413
EssentiaCare 52629 55413
UCare Medicare with M Health Fairview & North Memorial Health 52629 55413
UCare Connect + Medicare 52629 52629
UCare Connect 52629 52629
UCare - Minnesota Senior Health Options (MSHO) 52629 52629
UCare - Minnesota Senior Care Plus (MSC+) 52629 52629
UCare - MinnesotaCare (MnCare) 52629 52629
UCare - Prepaid Medical Assistance Program (PMAP) 52629 52629