*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, Gold and
UCare Individual & Family Plans with M Health Fairview Bronze, Bronze HSA, Silver, Silver HSA.
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.
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.
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.
UCare works with delegated organizations to handle the following types of authorization.
Direct all authorization questions to UCare's delegate, Fulcrum Health, Inc. | 1-877-886-4941
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 | 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 | 1-888-656-1952 (fax)
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.
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.
This form is intended to communicate patient referrals between medical and behavioral health providers.
612-676-3300 or 1-888-531-1493
Hours: 8 a.m. to 5 p.m., Monday through Friday
Inpatient admission notification is an important function of working with UCare members. UCare has prepared reminders for admission notification requirements.
Please see the Aug. 6 Provider Bulletin for details.
Effective for Medicare claims with 2020 dates of service, processed after July 21, 2020, UCare is temporarily suspending certain claims processing edits for claims submitted on behalf of members in the following products: UCare Medicare Plans, UCare Medicare with M Health Fairview & North Memorial, and EssentiaCare.
See the July 21 bulletin for details.
UCare has made some internal changes on how we are processing outpatient substance use disorder (SUD) services for individual/group (H2035), treatment coordination (T1016 U8 HN) and peer recovery support (H0038 U8) services.
Read the June 5th Provider Bulletin for details.
Providers should transition to the new forms by July 1.
Providers should transition to the new/updated forms by July 1.
Access to certain pharmacies may be limited because of temporary closures or building disruptions. UCare has prepared information to answer questions you may have for your patients.
Read the Pharmacy Access Bulletin.
As COVID-19 continues to impact Minnesota’s safety, health and financial security, UCare is taking several actions to help make health care more accessible and affordable.
See the May 28 Provider Bulletin for more information.
In November 2019, UCare issued a Provider Bulletin requiring Medicare Certified Home Health Care providers to submit claims in accordance with CMS billing guidelines. A new bulletin has been issued to provide additional clarification.
UCare is temporarily changing prior authorization and notification requirements for certain post-acute care services effective for dates of services April 20, 2020, to June 30, 2020, in response to COVID-19.
Beginning Aug. 1, 2020, UCare will introduce a new member ID card design for all products that will be issued for members who join UCare or seek a replacement ID card during the remainder of this year.
UCare’s 2020 Provider Manual contains critical information that providers need to know to effectively work with UCare and our members. It is important that providers reference the online manual regularly for up-to-date content. The Provider Manual has been updated to reflect current business practices.
Go to the 2020 Provider Manual
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