Eligibility & Authorization

 

Resources & Information

2019 Medical Services Authorization & Notification Grids:

Medical Services
 
EssentiaCare
 
UCare Medicare Plans with Fairview and North Memorial
 
UCare Individual and Family Plans, 
UCare Individual and Family Plans with Fairview
 
2019 Behavioral Health Authorization & Notification Grids:
 
Medicare
 
Medical Assistance
 
UCare Individual and Family Plans, 
UCare Individual and Family Plans with Fairview
 
2019 Injectable Drugs Authorization & Notification Grids:
 
UCare Medicare Plans/EssentiaCare
 
SNP/MSHO
 
SPP
 
2017 Medical Services Authorization & Notification Grids:
 
 
 
 
2017 Behavioral Health Authorization & Notification Grids:
 
 
 
 
2017 Injectable Drugs Authorization & Notification Grids:
 
2017 Authorization Requirements - Injectable Drugs  – UCare for Seniors/EssentiaCare
 
 
 
2017 Authorization Requirements - Injectable Drugs  – UCare Choices/Fairview UCare Choices

UCare works with delegated organizations to handle the following types of authorization.

Chiropractic Authorization:
Direct all authorization questions to UCare's delegate, Fulcrum Health, Inc. | 1-877-997-9491

Dental Authorization:
Direct all authorization questions to UCare's delegate, Delta Dental of Minnesota 

Therapy - PT, OT, ST Authorization:
Direct all authorization questions to UCare's delegate, Magellan Healthcare, Inc. | 952-225-5700, 1-888-660-4705 | 1-888-656-1952 (fax)

UCare State Public Programs: 1-855-648-1415 toll free or 651-768-1415
UCare for Seniors (Medicare Advantage): 1-855-648-1416 toll free or 651-768-1416
UCare Choices/Fairview UCare Choices: 1-855-648-1417 toll free or 651-768-1417  
EssentiaCare:  1-855-648-1416 toll free or 651-768-1416

Find drug coverage for each UCare health plan and forms to request exceptions or authorizations on our Pharmacy page.
  

•The Formularies page on the UCare provider website shows which drugs are covered, as well as everything you need to request exceptions or prior authorization. 

• Any medication, even on the formulary of covered drugs, requires prior authorization if the use is not supported by an FDA-approved indication. Use the exception request form and the contact information on our Formularies page.

 
Minnesota Restricted Recipient Program - State Public Programs
The forms below may be used when referring members to the UCare Restricted Recipient Program:
 
 
Restricted Member Program - Individual & Family Plans (formerly UCare Choices)
The forms below may be used when referring members to the Individual & Family Plans Restricted Member Program:
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If you have other questions, contact the Provider Assistance Center:

612-676-3300 or 1-888-531-1493
Hours:  8 a.m. to 5 p.m.,  Monday through Friday

Newsletters & Alerts

 

Provider Portal Unavailable

We are currently experiencing a technical issue on our provider portal. We are working on a resolution. We apologize for the inconvenience.

 

 

 

 

 

 

 

 

UCare Provider Manual Has Been Updated

2018 Provider Manual updates were made to Working with UCare's Delegated Business Services  Claims & Payment, Clinical Practice Guidelines, Member Appeals and Grievances, Home & Community Based Services, Public Health and Transportation Services. A change table in the Appendix links to specified changes in the manual. 
 

See the Provider Manual

 

 

Provider Assistance Center Phone Update

Our phone service is working, we’re continuing to monitor for any ongoing issues, please be aware we anticipate higher volumes as people catch up so we may experience longer wait times, especially on Monday. For faster assistance, please use the Provider Portal for claims, eligibility and authorization inquiries. We apologize for the inconvenience.