EssentiaCare

 

2020 Authorization and Notification Requirements - Medical Services

 

 

Forms & Information

For SNF Medically Necessary Private Room Requests, UCare will accept either the DHS Private Room Request Form found in the DHS Nursing Home portal or the necessary details added to the Nursing Home/Swing Bed Admission/Update Form.

 

UCare has partnered with Magellan to manage the utilization and quality of its members’ outpatient and in-home rehabilitative and habilitative therapy services. You must register to access functionality that will help you with your UCare Therapy Authorizations.

 

Direct all authorization questions to Magellan Healthcare | 952-225-5700 or 1-888-660-4705, Fax: 1-888-656-1952

This form is intended to communicate patient referrals between medical and behavioral health providers.

Universal Referral Form

Authorization Contact Information

 

UCare Clinical Services

Phone (local): 612-676-6705
Phone (toll free): 1-877-447-4384
Fax: 612-884-2499

Magellan Healthcare: Therapy - PT, OT, ST

Phone (local): 952-225-5700
Phone (toll free): 1-888-660-4705

Fax: 1-888-656-1952

Check Authorization Status

Login to check the status of an 
authorization request.

LOG IN

 

 

*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.

If you have other questions, contact the Provider Assistance Center:

612-676-3300 or 1-888-531-1493
Hours:  8 a.m. to 5 p.m.,  Monday through Friday

EssentiaCare

 

2020 Authorization and Notification Requirements -
Mental Health & Substance Use Disorder Services

 

Authorization Contact Information

 
UCare Behavioral Health
 

Phone:

612-676-6705
1-877-447-4384 toll free

Fax:

612-884-2033
1-855-260-9710 toll free

Check Authorization Status

Login to check the status of an 
authorization request.

LOG IN

 

*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.

If you have other questions, contact the Provider Assistance Center:

612-676-3300 or 1-888-531-1493
Hours:  8 a.m. to 5 p.m.,  Monday through Friday

EssentiaCare, UCare Medicare Plans,
UCare Medicare Group Plans

 

Find Medical Injectable Drug Prior Authorization Resources for UCare Medicare health plans and forms to request authorizations on our Pharmacy page.

  • Submit authorization requests 14 calendar days prior to the start of the service for non -urgent conditions.
  • All services are subject to member eligibility and benefit coverage.
  • For services that require an authorization, failing to obtain the authorization in advance may result in a denied claim.
  • UCare reserves the right to review and verify medical necessity for all services.
  • UCare does not instruct providers on how to bill. The codes listed on the authorization grid are for informational purposes only to assist our providers in the authorization process.
  • InterQual Decision Support tool and Medicare National Coverage Determinations (NCD), Local Coverage Determinations (LCD), Local Coverage Articles are used for medical necessity determinations. You may request a copy of the criteria used to make a medical necessity determination.
  • Medicare Provider of Service qualifications and licensure requirements must be met in order to provide services and submit claims to UCare.
  • Threshold limits are cumulative and can be exceeded when a member has seen multiple providers for the same service within a calendar year. Once threshold limits are exceeded, an authorization is required.
  • Contact UCare Provider Assistance Center (612-676-3000 or 1-888-531-1493) for additional information on thresholds.
  • Court-ordered mental health and substance use disorder services must be a covered benefit and meet Medicare coverage guidelines.
  • EssentiaCare: Out of network providers are not required to obtain an authorization for services. Medicare provider qualifications and benefits rules apply when an out of network provider is utilized.
 
Browse all 2019 medical services (PDF)                                                                           Browse all 2020 medical services (PDF)
 

Important Information for Medical Authorization & Notification

 

• Submit authorization requests 14 calendar days prior to the start of the service for non-urgent conditions.

• All services are subject to member eligibility and benefit coverage.

• For services that require an authorization, failing to obtain the authorization in advance may result in a denied claim.

• UCare reserves the right to review and verify medical necessity for all services.

• UCare does not instruct providers on how to bill. The codes listed on the authorization grid are for informational purposes only to assist our providers in the authorization process.

• InterQual Decision Support tool and Medicare National Coverage Determinations (NCD), Local Coverage Determinations (LCD) and Local Coverage Articles are used for medical necessity determinations. You may request a copy of the criteria used to make a medical necessity determination.

• Contact UCare Provider Assistance Center (612-676-3000 or 1-888-531-1493) for additional information on thresholds.

• Essentia Health Providers – Contact Essential Health Managed Care Support Services.

• Authorization is not required for orthotics and prosthetics.

EssentiaCare: Out of network providers are not required to obtain an authorization for services. Medicare provider qualifications and benefit rules apply when an out of network provider is utilized.

 
Browse all 2019 behavioral health services (PDF)
Browse all 2020 behavioral health services (PDF)

Q2 2020 Update to UCare's Provider Manual

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. UCare has prepared a Provider Bulletin outlining the key updates.

Go to the  2020 Provider Manual    

  

 

UCare Implements New Transportation Management Software

UCare has rolled out a new transportation system to schedule rides for our members. The new service will continue to be called UCare HealthRide.

 

Read the June 22 Provider Bulletin.