*UCare Medicare Plans include Prime, Value, Essentials Rx, Standard, Complete, Classic and Total.
UCare Individual & Family Plans include Bronze, Silver, Gold, Core and M Health Bronze and Silver.
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.
Behavioral Health Case Management Referral Form (New 10.11.19)
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 only at this time.
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
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.
•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.
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
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.
During 2019, UCare will temporarily suspend the requirement for prior authorizations for services delivered to members with UCare Individual & Family Plans and UCare Individual & Family Plans with Fairview.
UCare has updated its authorization requirements for CTSS thresholds and SUD inpatient admission and residential treatment services to align with DHS changes.
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.
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.
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.
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