*UCare Medicare Plans include Prime, Value, Essentials Rx, Standard, Complete, Classic and Total.
UCare Individual & Family Plans include Bronze, Silver, Gold, Core, Fairview Bronze and Fairview Silver.
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 (formerly UCare for Seniors) (Medicare Advantage): 1-855-648-1416 toll free or 651-768-1416
UCare Individual & Family Plans / UCare Individual & Family Plans with Fairview (formerly 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
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
Read about HCBS billing requirement reminder, Ineligible Provider List update, PANDAS and PANS pediatric autoimmune coverage requirements, SNF CMS Methodology Change and Documentation for Bipolar Disorder.
UCare recently updated its Utilization Review Criteria. A memo was developed to outline the changes to Behavioral Health and Medical Care criteria.
Starting July 1, 2019, UCare will adopt the Department of Human Services’ (DHS) Preferred Drug List (PDL) for members in Prepaid Medical Assistance Program, MinnesotaCare, Minnesota Senior Care Plus and UCare Connect.
Please see the June 4 Provider Bulletin
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 the following chapters of the Provider Manual: Provider Responsibilities, Provider Credentialing, Claims & Payment, Member Appeals & Grievances, Behavioral Health, Comprehensive Outpatient Rehabilitation Facility Services, UCare's FQHC - RHC Payment Carve-Out Process, Interpreter Services and Nursing Facility Services. Specific updates are called out in the Appendix.
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