*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. | 1-877-997-9491
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.
612-676-3300 or 1-888-531-1493
Hours: 8 a.m. to 5 p.m., Monday through Friday
In this edition, read the upated alert for the Online Submission of the Claims Reconsideration Request Form Delay, 2019 UCare Provider Manual update, Provider FAQs – New UCare Claims System, Healthy Saving Discount program, and documentation for Deep Vein Thrombosis (DVT).
UCare has identified some additional work required to accurately report member eligibility status for 2019 Individual & Family Plan members in our Interactive Voice Response and our 270/271 HIPAA Transaction. We anticipate 2019 IFP member eligibility should be available in our IVR system by Jan. 18, 2019, and in the 270/271 HIPAA transaction by Jan. 31, 2019. We apologize for this inconvenience. Providers can obtain updated member eligibility status in UCare’s Provider Portal and by contacting the Provider Assistance Center. Member eligibility status is available for all other UCare health plans using the IVR and the 270/271 HIPAA Transaction.
See the full bulletin .
Medicare-eligible individuals have multiple opportunities to enroll in the most appropriate plan to meet their needs.
We’ve prepared a Provider Bulletin to help explain the following enrollment periods:
This bulletin provides a summary of the UCare pharmacy formulary changes taking effect Jan. 1, 2019. Plan names have changed for 2019 for Medicare plans and Individual & Family plans.
UCare's 2019 authorization and notification requirements are now available on our website at ucare.org/providers, under the Eligibility & Authorization section: State and Public programs, UCare Medicare Pans, EssentiaCare, Behavioral Health and Pharmacy.
During 2019, UCare will temporarily suspend the requirement for prior authorizations for services delivered to members with UCare Choices and Fairview UCare Choices (renamed as UCare Individual & Family Plans and UCare Individual & Family Plans with Fairview in 2019).
Effective January 1, 2019, UCare will make changes that affect claims submission for only UCare Choices and Fairview UCare Choices plans (to be renamed UCare Individual & Family Plans and UCare Individual & Family Plans with Fairview on January 1, 2019).
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