*UCare Medicare Plans include Aware, Classic, Complete, Essentials Rx, Prime, Standard, Value and Value Plus,
Advocate Choice, Advocate Choice Plus and UCare Medicare Supplement.
UCare Individual & Family Plans include Core, Bronze, Bronze HSA, Silver, Silver HSA and Gold; and
UCare Individual & Family Plans with M Health Fairview Bronze, Bronze HSA, Silver, Silver HSA and Gold.
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 (toll free)
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 and Institutional/Equivalent Special Needs Plan (I E SNP) (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)|
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 (toll free)
Hours: 8 am to 5 pm, Monday through Friday
Protest activity in and around the Twin Cities may limit access to certain pharmacies. To assist providers, UCare has created a list of frequently asked questions about the situation.
Read the April 12 Pharmacy bulletin for details.
Starting June 1, 2021, UCare is updating prior authorization criteria for 21 drugs that are on the UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview formulary.
See the April 12 bulletin for details.
The Food and Drug Administration has authorized Emergency Use Authorization and approved multiple monoclonal antibody therapies for treatment of mild-to-moderate COVID-19 in adults and pediatric patients who are at high risk for progressing to severe COVID-19 and/or hospitalization.
See the April 6, 2021 Provider Bulletin for details.
Learn about COVID-19 Information for Providers, UCare and Minnesota Medical Association Collaborate on Health and Racial Equity, Ineligible Provider List Updated, COVID-19 Vaccine Outreach, Documentation Improvement: Parkinson's Disease, 2021 Summer Camps for Young UCare Members and more.
Medicare claims submitted with billing or rendering provider specialty/taxonomy not included on the Medicare/Supplier crosswalk will deny for invalid provider taxonomy.
See the March 31, 2021 Provider Bulletin for details.
UCare’s 2021 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.
Read the Provider Bulletin.
Go to the Provider Manual.
Starting April 1, 2021, UCare is updating prior authorization criteria for 14 drugs that are on the UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview formulary.
See the Feb. 15 bulletin for details.
Effective immediately, UCare is changing the process to request updates to the provider’s payment and remittance selections.
Read the Dec. 18 bulletin for additional details on the changes.
New codes have been identified for 2021 and will be accepted into the UCare system as of the effective dates but are subject to the editing update and implementation dates.
See the Dec. 29 bulletin for details.
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