Commercial products for individual and family coverage available through MNsure, including UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview.
UCare Medicare Plans, UCare Medicare Plans with M Health Fairview and North Memorial, UCare Medicare Group Plans, UCare Advocate Plans and EssentiaCare.
UCare Connect + Medicare and Minnesota Senior Health Options (MSHO)
UCare Connect (Special Needs BasicCare), Minnesota Senior Care Plus (MSC Plus), MinnesotaCare (MnCare), Prepaid Medical Assistance Program (PMAP)
Our Medication Therapy Management (MTM) Program is a free service for eligible UCare members to optimize individual medication therapy, experience and outcomes. Members receive a one-on-one consultation with a pharmacist to review their entire medication regimen (including prescription, over-the-counter medications and herbal supplements) to help resolve any potential medication-related issues regarding indication, effectiveness, safety and convenience.
UCare partners with many pharmacists across the state of Minnesota and provides reimbursement for MTM services.
Following is a high-level overview of the MTM Program. Please refer to the MTM section of the provider manual for full program information including detailed topics such as eligibility, expectations, audits, billing and more.
UCare’s expectation is that MTM services will be billed using MTM CPT codes 99605, 99606 and 99607. Billing is based on complexity, not time, for all lines of business.
Important Time Sensitive Requirement Reminders
Continuity of Care Document (CCD)
MTM providers are required to maintain and submit a CCD for all Medicare visits. It is acceptable to send information for non-Medicare members as well.
For any questions or inquiries regarding the MTM program at UCare, please contact us via email at firstname.lastname@example.org.
Additional Helpful Resources
The Pharmacy and Therapeutics Committee, a group of practicing physicians and pharmacists, meets up to six times per year to recommend medication inclusion or exclusion to our formularies. The Pharmacy and Therapeutics Committee evaluates drugs based on clinical evidence and efficacy (drug monographs, peer reviewed literature, compendia resources), therapeutic guidelines, medication safety and comparable data to other therapeutic alternatives. This committee reviews all new drugs approved by the FDA, new generics, new dosage forms, new indications as well as regular therapeutic class reviews and annual review of all utilization management criteria.
Care Continuum, a subsidiary of Express Scripts
Online (ePA): ExpressPAth Portal at www.express-path.com/.
612-676-3300 or 1-888-531-1493
Hours: 8 a.m. to 5 p.m., 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.
Starting May 1, 2021, UCare is updating prior authorization criteria for 11 drugs that are on the UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview formulary.
See the March 11 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.
UCare is temporarily changing prior authorization and notification requirements for certain post-acute care services effective for dates of services April 20, 2020, to June 30, 2020, in response to COVID-19.
Starting Jan. 1, 2021, UCare began denying claims for providers administering Part D vaccines in their clinics. Provider will need to bill both the vaccine and administration through the member’s Part D benefit.
See the Feb. 4 bulletin for details.
On May 28, 2020, the Food and Drug Administration (FDA) announced they requested five drug manufacturers to voluntarily recall their Metformin Extended-Release (ER) products from the marketplace due to higher than acceptable levels of N-Nitrosodimethylamine (NDMA). Impacted manufacturers have submitted recall notices to the FDA.
Read the June 11 Provider Bulletin for details on which manufacturers are affected, what prescribers should do and how UCare is notifying impacted members.
Providers should transition to the new forms by July 1.
On Sept. 21, 2020, the FDA announced a voluntary recall of all unexpired albuterol inhalers manufactured by Perrigo. This recall is to the retail pharmacy level. The FDA urges patients to continue using the inhaler they have on hand. UCare’s pharmacy department is contacting impacted members and their providers.
Read the October 6 Bulletin for more information.
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.
Starting March 1, 2021, UCare is adding a prior authorization requirement for Victoza and Nubeqa for members on UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview.
See the Jan 15, 2021 Provider Bulletin for details.
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