Eligibility & Authorization

 

 

*UCare Medicare Plans include Prime, Value, Essentials Rx, Standard, Complete, Classic and Total.
UCare Individual & Family Plans include Bronze, Bronze HSA, Silver, Silver HSA, Core and Gold 
UCare Individual & Family Plans with M Health Fairview Bronze, Bronze HSA, Silver, Silver HSA.

Resources & Information

2020 Medical Services Authorization & Notification Grids:

Medical Services for State Public Programs, Special Needs Plans, UCare Medicare Plans and UCare Medicare with       M Health Fairview & North Memorial
 
EssentiaCare
 
UCare Individual and Family Plans, 
UCare Individual and Family Plans with M Health Fairview
 
2020 Behavioral Health Authorization & Notification Grids:
 
Medicare
 
Medical Assistance
 
UCare Individual and Family Plans, 
UCare Individual and Family Plans with M Health Fairview
 

2020 Medical Injectable Drug Authorization & Notification Requirements:

2020 Medical Injectable Drug Authorization List

Find medical injectable drug prior authorization resources and forms to request authorizations on our Pharmacy page for all UCare health plans. 

 

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
 

The Behavioral Health Case Management Referral Form is completed when you have a UCare PMAP, MNCare, MSHO or MSC+ member who has a complex Behavioral Health condition. 

Mental Health & Substance Use Disorder Case Management Referral Form  (New 5.26.20)

The Care Management Referral form is completed when you have a member/patient who you feel would benefit from care coordination services and is actively enrolled in UCare Connect, UCare Connect + Medicare, PMAP (under 65), UCare Medicare Plans or Individual & Family Plans. 

Care Management Referral Form-PDF

Care Management Referral Form-WORD

The Complex Case Management Referral form is completed when you have a medically complex member/patient who you feel would benefit from short term / intensive medical case management. They typically have a new critical medical event, multiple medical diagnoses with challenges or high medical costs/utilization. This program is for UCare Medicare and Individual & Family Plans and PMAP/MNCare. 

Complex Case Management Referral Form - PDF

Complex Case Management Referral Form-WORD

 

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. | 1-877-886-4941 (toll free)

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

UCare State Public Programs: 1-855-648-1415 (toll free) or 651-768-1415
UCare Medicare Plans (Medicare Advantage): 1-855-648-1416 (toll free) or 651-768-1416
UCare Individual & Family Plans / UCare Individual & Family Plans with M Health Fairview: 1-855-648-1417 (toll free) or 651-768-1417  
EssentiaCare: 1-855-648-1416 (toll free) or 651-768-1416

Medical Injectable Drug Authorizations:
Direct all authorization requests to UCare’s delegate: Care Continuum, a subsidiary of Express Scripts Online (ePA) at www.express-path.com/ | Phone: 1-800-818-6747 (toll free) | Fax: 1-877-266-1871 

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

In order for services to be eligible for payment by UCare, the services must meet UCare’s standards for coverage, including medical necessity criteria. Coverage and benefits vary significantly among different UCare plans. Member Handbook or Member Contracts specific to the member’s UCare plan.

Medical Necessity Criteria

Medical Necessity Criteria Request Forrn

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

Find medical injectable drug prior authorization information for each UCare health plan and forms to request 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. 

 
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 
The forms below may be used when referring members to the Individual & Family Plans Restricted Member Program:

This form is intended to communicate patient referrals between medical and behavioral health providers.

Universal Referral Form

If you have other questions, contact the Provider Assistance Center:

612-676-3300 or 1-888-531-1493 (toll free)
Hours:  8 am to 5 pm,  Monday through Friday

Newsletters & Alerts

 

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