Credentialing and Recredentialing

  • See providers that require credentialing
  • Providing services to members before you are both contracted and credentialed will result in claims being denied, rejected or processed as out of network. 
  • Each practitioner within your practice will have their own credentialing approval date. These dates may vary across practitioners, even if they are part of the same practice.
  • Credentialed practitioners are enrolled in all plans/products that the Clinic/Group is contracted under.
  • Recredentialing is performed every three years, or earlier for any recredentialing files with variations from credentialing. Recredentialing is conditional upon the practitioner continuing to meet UCare’s credentialing standards and quality performance standards.
  • All actions related to acceptance, denial, discipline and termination of participation status for a practitioner or organization are governed by UCare’s Credentialing Plan .
  • For additional information including the Credentialing/Recredentialing Process, please see the Credentialing chapter of UCare’s Provider Manual .
  • UCare’s Credentialing Department has a dedicated email box for credentialing-related questions – credentialinginfo@ucare.org.
Initial Credentialing
  1. Follow the online credentialing process (preferred method) by visiting Minnesota Credentialing Collaborative (MCC)/ApplySmart. For issues with MCC/ApplySmart, please call their Customer Service line at 847-425-4616.
    • Applications should be submitted at least three months prior to an individual practitioner's start date at a clinic.
    • UCare uses a standard 90-day turnaround time and does not retrospectively apply effective dates.
       
  2. You can also submit your credentialing application via email to credentialinginfo@ucare.org
    Initial Credentialing Application  (DOCX)
     
  3. For credentialing questions, please email credentialinginfo@ucare.org.   

If you are having difficulty downloading credentialing forms, please send an email to credentialinginfo@ucare.org

PLEASE NOTE:  If an application is incomplete, it will be returned and notification will be given through ApplySmart. The application will need to be resubmitted along with all missing information. The 90-day turnaround will start once a completed application is received from ApplySmart.

 

Recredentialing
  1. When recredentialing is requested from UCare, applications should be submitted through Minnesota Credentialing Collaborative (MCC)/ApplySmart.
  2. You can also submit the Uniform Re-Credentialing Application at www.mncred.org. When recredentialing is requested from UCare, applications are required to be submitted through this website.
  3. If an individual practitioner’s recredentialing application is not submitted in the time allowed, the practitioner’s UCare participating network status will be administratively terminated. Once terminated, no claims will pay, and the practitioner will need to complete the initial credentialing process. 
  1. Submit your credentialing/recredentialing application via email to credentialinginfo@ucare.org.

MN Uniform Facility Credentialing Application  (PDF)

  1. For credentialing questions, please email credentialinginfo@ucare.org.

Contact UCare Delegates to Credential These Practitioners:

 

Chiropractic Fulcrum Health Inc.: 1-877-886-4941                                   Dental Delta Dental of Minnesota: 1-800-448-3815 

Phone

Call our toll-free helpline. You may remain anonymous. If we are unavailable when you call, please leave a message.
 
Phone:  1-877-826-6847

Postal Mail

Send us a letter and/or documents you would like us to review.
 
UCare
Attn: Special Investigation Unit
P.O. Box 52
Minneapolis, MN 55440-0052

Email

Send us an email message with your question or concern.
 

 

 

Updated February 2020

Region

UCare Product

Eligibility

Service Area
(Minnesota Counties)

Narrow network?

North

UCare Medicare Plans (HMO-POS)

  • Essentials Rx
  • Total
  • Value
  • UCare Medicare Group Plans*
  • Must have Medicare Part A & Part B to enroll

    Do not have end-stage renal disease

    Aitkin, Becker, Beltrami, Carlton, Cass, Clay, Clearwater, Cook, Crow Wing, Douglas, Grant, Hubbard, Itasca, Kanabec, Kittson, Koochiching, Lake, Lake of the Woods, Mahnomen, Marshall, Morrison, Norman, Otter Tail, Pennington, Pine, Polk, Red Lake, Roseau, St. Louis, Todd, Wadena, Wilkin All UCare network providers
    North

    UCare Medicare Plans (HMO-POS)

  • Classic
  • Must have Medicare Part A & Part B

    Do not have end-stage renal disease

    Aitkin, Becker, Carlton, Cass, Clay, Cook, Crow Wing, Hubbard, Kanabec, Lake, Morrison, Pine and St. Louis All UCare network providers
    Metro

    UCare Medicare Plans (HMO-POS)

  • Prime
  • Essentials Rx
  • Complete
  • Classic
  • Total
  • Value
  • UCare Medicare Group Plans*
  • Must have Medicare Part A & Part B

    Do not have end-stage renal disease

    Anoka, Benton, Carver, Chisago, Dakota, Hennepin, Isanti, Mille Lacs, Ramsey, Scott, Sherburne, Stearns, Washington, Wright All UCare network providers
    South

    UCare Medicare Plans (HMO-POS)

  • Standard
  • Complete
  • Total
  • Value
  • UCare Medicare Group Plans*
  • Have Medicare Part A & Part B

    Do not have end-stage renal disease

    Big Stone, Blue Earth, Brown, Chippewa, Cottonwood, Dodge, Faribault, Fillmore, Freeborn, Goodhue, Houston, Jackson, Kandiyohi, Lac qui Parle, Le Sueur, Lincoln, Lyon, Martin, McLeod, Meeker, Mower, Murray, Nicollet, Nobles, Olmsted, Pipestone, Pope, Redwood, Renville, Rice, Rock, Sibley, Steele, Stevens, Swift, Traverse, Wabasha, Waseca, Watonwan, Winona, Yellow Medicine All UCare network providers
    South

    UCare Medicare Plans (HMO-POS)

  • Classic
  • Have Medicare Part A & Part B

    Do not have end-stage renal disease

    Blue Earth, Dodge, Faribault, Fillmore, Freeborn, Goodhue, Houston, Le Sueur, Mower, Nicollet, Olmsted, Rice, Steele, Wabasha, Waseca, Watonwan, Winona All UCare network providers

    In-Network Services

    Primary Care Office Visits $0 copay $25 copay $0 copay $20 copay $0 copay $0 copay $0 copay
    Specialist Office Visits $35 copay $50 copay $20 copay $45 copay $40 copay $10 copay $35 copay
    Inpatient Hospital Care $400 copay per stay (not per day), then 100% coverage, unlimited days per admission $300 copay per day (days 1 - 5), then 100% coverage, unlimited days per admission $250 copay per stay (not per day), then 100% coverage, unlimited days per admission $300 copay per day (days 1 - 5), then 100% coverage, unlimited days per admission $500 copay per day (days 1 - 3), then 100% coverage, unlimited days per admission $100 copay per stay (not per day), then 100% coverage, unlimited days per admission $150 copay per day (days 1 - 5), then 100% coverage, unlimited days per admission
    Urgent Care $50 copay $45 copay $50 copay $50 copay $40 copay $0 copay $50 copay
    Worldwide Emergency Care $100 copay $90 copay $100 copay $100 copay $90 copay $100 copay $100 copay
    Medicare Part D Prescription Drug Coverage* No Prescription Drug Coverage $400 deductible | Copays based on drug tiers $200 deductible | Copays based on drug tiers $400 deductible | Copays based on drug tiers $400 deductible | Copays based on drug tiers Copays based on drug tiers $200 deductible | Copays based on drug tiers
    Preventive Dental Coverage Yes No Yes Yes Yes No No
    Vision Coverage-Routine Routine Eye Exam: 1 per year, $0 Copay Routine Eye Exam: Not Covered Routine Eye Exam: 1 per year, $0 Copay Routine Eye Exam: 1 per year, $0 Copay Routine Eye Exam: 1 per year, $0 Copay Routine Eye Exam: 1 per year, $0 Copay Routine Eye Exam: 1 per year, $0 Copay
    Vision Coverage-Diagnostic Diagnostic Eye Exam: $35 copay Diagnostic Eye Exam: $50 copay Diagnostic Eye Exam: $20 copay Diagnostic Eye Exam: $45 copay Diagnostic Eye Exam: $40 copay Diagnostic Eye Exam: $10 copay Diagnostic Eye Exam: $35 copay
    Hearing Services-Routine Routine Hearing Exam: 1 per year, $0 Copay Routine Hearing Exam: Not Covered Routine Hearing Exam: 1 per year, $0 Copay Routine Hearing Exam: 1 per year, $0 Copay Routine Hearing Exam: 1 per year, $0 Copay Routine Hearing Exam: 1 per year, $0 Copay; $500 allowed every 36 months for hearing aids Routine Hearing Exam: 1 per year, $0 Copay
    Hearing Services-Diagnostic Diagnostic Hearing Exam: $35 copay Diagnostic Hearing Exam: $50 copay Diagnostic Hearing Exam: $20 copay Diagnostic Hearing Exam: $45 copay Diagnostic Hearing Exam: $40 copay Diagnostic Hearing Exam: $10 copay Diagnostic Hearing Exam: $35 copay
    Out of Pocket Maximum $3,400 $5,000 $3,400 $3,400 $4,500 $3,000 $3,000

     

    * Part D deductible only applies to some drugs. See the Drug Formulary for details. 

    Pharmacy benefit information