Coronavirus (COVID-19) Information For Providers

 

 

UCare is committed to protect our members and the community from the spread of coronavirus (COVID-19). The COVID-19 situation is changing quickly, and we are monitoring changes closely.

To assist our provider partners in navigating this fluid situation, UCare has developed a list of frequently asked questions. We will continue to add common questions and update this page with additional information as it becomes available.

PAGE LAST UPDATED 4-9-20

 

Billing/Payment

UCare will cover telehealth services for members in all UCare plans and will be reimbursing services as if the services were done face to face.

How is UCare covering the COVID-19 test and treatment?

  • UCare will cover copays, coinsurance or deductibles for provider-ordered COVID-19 tests meeting Centers for Disease Control and Prevention (CDC) guidelines for members in all our plans, for the immediate future.  

  • During this time, we will cover copays, coinsurance or deductibles for medically necessary clinic and urgent care visits when a COVID-19 test is administered for members in all of our plans.

  • UCare will waive coinsurance, copays and deductibles for in-network hospital services to treat COVID-19 through May 31, 2020, for members in all of our plans. At that time, we will evaluate whether to extend it.

What procedure codes should be used for COVID-19 testing?

UCare can now accept claims for COVID-19 tests using HCPCS codes U0001, U0002 and CPT code 87635. Providers should follow CDC ICD-10CM Official Coding Guidelines effective 2/20/2020

  • HCPCS U0001 and U0002 are effective for dates of service 2/4/20 and after.

  • CPT 87635 is effective for dates of service 3/13/20 and after.

  • HCPCS and CPT testing codes can coexist for now. At this time there are currently no plans at UCare to consolidate the codes down.

UCare is waiting for published payment rates from the Centers for Medicare & Medicaid Services (CMS) and the Minnesota Department of Human Services (DHS) to determine reimbursement for providers.

The following links provide additional information:

 

How is UCare addressing access to medication, drug shortages and formulary status of critical drugs at this time?

UCare’s Pharmacy Department has been closely monitoring the COVID-19 developments and taking appropriate action to ensure our members have access to medication. The March 26, 2020, Provider Bulletin  addresses these questions and UCare’s response.

 

We are working rapidly to finalize our system edits to recognize changes and modification in the payment of claims. Claims currently submitted may process based on historic claims processing guidelines until system updates are in place. We will work with our providers to correct any inaccurate payments. We appreciate your patience during this challenging time.

 

Adding Practitioners/Locations on a Temporary Basis

Can I add practitioners to another location on a temporary basis due to COVID-19?

Yes, you can add a practitioner to a new location temporarily as long as UCare shows that the practitioner has current credentialing and the location is one that you would typically affiliate a practitioner to.  UCare Credentialing will notify you if credentialing is necessary.  

 

Where do I send requests to add practitioners to locations on a temporary basis due to COVID-19?

Please send spreadsheets with the changes to credentialinginfo@ucare.org

 

Is a spreadsheet required when submitting adds?

Yes, please be sure to include the Last Name, First Name, Title, Individual NPI, License State, License ID, Practice Location Address, Effective Date, Tax ID, Billing NPI and Office Phone number.

 

How long will it take for UCare systems to be updated?

UCare will be working the temporary adds due to COVID-19 in an expedited timeframe of 5 business days. UCare will send a notification to the person who submitted the spreadsheet when UCare systems have been updated.

 

Can I add permanent practitioners or locations using this process?

No, all adds due to COVID-19 will be loaded with an indicator that will allow us to identify and remove them after the COVID-19 pandemic has passed. Please continue to use the add forms located on ucare.org to add practitioners and locations on a permanent basis.

 

How do I know when the temporary practitioners and locations are removed?

UCare will communicate through our provider newsletter, Health Lines, the planned removal date for the practitioners and locations that were added on a temporary basis due to COVID-19.

 

What if we decide that we want to keep some of the temporary adds in place after the COVID-19 pandemic is over?

A MN Uniform Practitioner Change Form would need to be submitted to credentialinginfo@ucare.org or one of the add forms located on ucare.org will need to be completed to add them permanently.

 

Credentialing

What are the credentialing requirements for out-of-state providers or in-network providers who temporarily move locations to test and treat UCare members for COVID-19?

Subject to applicable state licensure laws, UCare will follow recent CMS guidelines regarding temporarily waiving requirements that licensed out-of-state providers also be licensed in the state where they are providing services. This applies to all UCare plans. 

 

Telehealth

Does UCare allow E-Visits, Telehealth and Telephone Visits for its members?

UCare will cover telehealth services for members in all UCare plans and will be reimbursing services as if the services were done face to face.

Individual & Family Plans:

Telehealth professional services can be furnished by the following expanded list of providers:

  • Physician

  • Nurse Practitioner (NP)

  • Physician Assistant (PA)

  • Nurse midwife

  • Clinical Nurse Specialist (CNS)

  • Certified Registered Nurse Anesthetist (CRNA)

  • Licensed Social Worker (LICSW)

  • Licensed Professional Clinical Counselor (LPCC)

  • Licensed Professional Counselor (LPC)

  • Licensed Marriage and Family Therapist (LMFT)

  • Licensed Psychologist

  • Either Masters level or PhD Registered dietician or nutrition professional

Medicare:

UCare will follow current Telehealth guidelines, as well as the temporary CMS Guidance published March 17, 2020 - https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet. This includes expanding the definition of originating site to include professional services furnished in all eligible health care settings, and in the patient’s residence. In addition, UCare will follow the temporary guidelines expanding the technology that can be used to furnish an eligible telehealth service.

CMS did not expand the list of eligible telehealth services or eligible providers, and UCare will follow these guidelines.   

Professional services can be furnished by a:

  • Physician

  • Nurse Practitioner (NP)

  • Physician Assistant (PA)

  • Nurse midwife

  • Clinical Nurse Specialist (CNS)

  • Certified Registered Nurse Anesthetist (CRNA)

  • Clinical psychologist

  • Clinical social worker

  • Registered dietician or nutrition professional

Clinicians who may not independently bill for evaluation and management visits (e.g., physical therapists, occupational therapists, speech language pathologists, clinical psychologists) can also provide these e-visits and bill the following codes:

  • G2061: Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes

  • G2062: Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes

  • G2063: Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes

https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

State Public Programs:

UCare will follow DHS Telehealth guidelines. 

 

Waiving of Procedures

Will any prior authorization requirements be waived?

Prior authorizations are not being waived at this time.

For all plans, UCare will continue to use its current prior authorization guidelines. Please refer to UCare’s authorization grids for these requirements.

Please note, per UCare’s current guidelines, we do not require a 3 day qualifying hospital stay for a Skilled Nursing Facility (SNF) admission for plans with a Medicare Skilled Nursing Home benefit. SNF admissions require notification upon admission and concurrent review for ongoing stay.


How will you handle previously approved prior authorizations for elective procedures and services?

In light of many non-essential health care services being postponed due to the Covid-19 outbreak, UCare is proactively extending prior authorizations for approved elective surgeries that were requested between Jan. 1, 2020, and March 31, 2020. We will be sending out new letters with approved prior authorization extension dates of Dec. 31, 2020, for elective surgeries only. If you have not received a letter by June 1, 2020, please contact the Clinical Services Department via phone at 612-676-6705 / 1-877-447-4384 or fax to 612-884-2499 / 1-866-610-7215.

Member Frequently Asked Questions

Where can I find information for UCare members about COVID-19?

UCare has prepared a list of COVID-19 Frequently Asked Questions to assist our members and provide general information about UCare’s service to members during this time.

 

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