To find a specific provider communication, use the “Document Name,” “Date Published” or “Communication Type” columns or enter a key word in the search box.
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’s launch of the online submission of the Provider Claim Reconsideration Request Form has been delayed. At this time, Providers should continue to use the current form.
Read the March 4 Provider Bulletin
UCare is implementing a new claims system platform over the next few years. To assist providers, we have prepared a list of frequently asked questions regarding the transition.
As UCare processes claims in the new claims system platform for members in Individual & Family Plans, providers will notice differences in the EOPs, ACH Payments, demographic updates and more.
See the full bulletin for additional details.
UCare has developed a bulletin regarding issues that may cause claim rejection edits.
See the full bulletin.
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:
UCare uses multiple automated claims editing and pricing applications to ensure consistent and accurate processing of claims. Please allow appropriate time for the updates to be put into production.
Changes have been announced for Personal Care Assistance (PCA) and Home Care Nursing (HCN) providers who provide services to Minnesota Health Care Program recipients under age 65 who are enrolled with UCare.
On Jan. 1, 2019, UCare will make changes that affect claims edits for only UCare Choices and Fairview UCare Choices plans (to be renamed UCare Individual & Family Plans and UCare Individual & Family Plans with Fairview in 2019).
UCare's 2019 authorization and notification requirements are now available on our website at ucare.org/providers, under the Eligibility & Authorization section: State and Federal programs, UCare Medicare Plans, 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).
UCare informs providers of critical business reminders for NCQA accreditation requirements for Credentialing, Pharmacy, Complex Case Management, Utilization Management, Member Rights and Responsibilities, and Disease Management.
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To find a specific provider communication, use the “Document Name,” “Date Published” or “Communication Type” columns or enter a key word in the search box.
|Document Name||Date Published||Communication Type||Meta|
|Physician Pricer||2017-01-18||Bulletin||Medicare Pricing Software, UCare for Seniors and EssentiaCare, UFS, MSHO, Connect + Medicare, Multiple Procedure Payment Reductions MPPR, Diagnostic imaging, Diagnostic Ophthalmology, Diagnostic Cardiology, technical services, Physical, Occupational and Speech Therapies, individual therapist, a group practice, practice expense (PE), Endoscopy, base “family” code, base endoscopic procedure, Distinct Procedural Service and X-(ESPU) Modifiers, billed separately, National Correct Coding Initiative (CCI) edits, Professional Modifier Payment Policy, Anesthesia services, Medicare Anesthesia Payment Policy, Medicare Bundling edits,|
|Taxonomy FAQs||2017-02-09||FAQs||Frequently Asked Questions, FAQ, taxonomy codes, professional claims, facility claims, atypical providers, NPI number, physician or rendering taxonomy code, facility/billing taxonomy code, payment calculations, Medicare professional services, Centers for Medicare and Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES), error category of A6, error code 145, 277CA report, clearinghouse, the National Uniform Claim Committee (NUCC) 837P Loop (CMS1500) Professional, 837I Loop (UB04) Institutional, EDI Segment, PRV Codes, 2000A, 2310B, 2310A, adjudicate claims, other insurance Medicare crossover claims ,clearinghouses, rendering provider NPI, billing provider NPI/taxonomy information|
|August 2017 health lines||2017-08-16||health lines||No payments for service outside US, child teen checkups, wellness visits, American Cancer Society, guidelines update 2012, wewbinar, cervical cancer screening, antidepressant medication management provider toolkit, depression linked to several chronic diseases and conditions, performance improvement project (PIP), documentation for peripheral arterial disease PAD, plaques on the artery walls,|
|February 2017 health lines||2017-02-15||health lines||UCare Provider Manual updated, Authorizations and Notifications; Claims and Payments; and Fraud, Waste and Abuse, National Coverage Determinations, CMS ICD-10-CM diagnosis codes, claims editing softwre, not updated codes, message from CMS,Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, observation services in an outpatient status for more than 24 hours, Medicare Outpatient Observation Notice, 270/271 transaction, McKesson PCS Support, clearinghouse, UCare’s 270/271 Companion Guide, JW Modifier, Reporting Drug Waste, Healthcare Common Procedure Coding System (HCPCS) Level II modifier, Part B drug claim, accurate medical records, JW-Modifier-FAQs, Chapter 17 of the CMS Medicare Claims Processing Manual (Section 40), MLN Matters MM9603, timely availability of appointment,s Consumer Assessment of Healthcare Providers & Systems (CAHPS) Survey, Medicare Star Ratings, Health Outcomes Survey highlight: Monitoring Physical Activity Five-Year Trend, Documentation improvement: chronic|
|January 2017 health lines||2017-01-17||health lines||Update on taxonomy code requirements, professional and/or facility claims, clearinghouse, Medicare-Assist at Surgery, Medicare guidelines, append -AS modifier, -80 Assistant Surgeon, -81 Minimal Assistant Surgeon, -82 Assistant Surgeon, Health Outcomes Survey, UCare for Seniors UFS, Minnesota Senior Health Options MSHO, falls prevention, UCare’s fitness benefits , Strong & Stable kit, Documentation improvement: diabetes, Improving patient health through collaboration, Behavioral health, Collaborating and sharing comprehensive patient information, Emergency department, decrease non-emergent conditions, clarity to medical records, ICD-10 codes, patient’s complete health profile|
|November 2017 health l ines||2017-11-15||health lines||Management of Heart Failure in Adults clinical practice guideline, Quality Improvement Advisory and Credentialing Council (QIACC), credentialing notification of terminations, Involuntary termination, Resignation from position, Leave of absence (LOA), Sabbatical, Resigned inactive state license status, No longer licensed in the state, Deceased, Model of Care MOC training for providers for UCare's MSHO, UCare Connect+Medicare, advance directive resources, health care directive, Advance Directive Audit (ADA), medical record keeping practices, percentage of compliant records, Minnesota Senior Health Options, UCare Connect, UCare Choices, UCare for Seniors, EssentiaCare, PMAP Olmsted County, documentation for major depression, flu shots recommendation|
|Provider Assurance Statement for Telemedicine Required to Deliver Telemedicine Services to Certain UCare Members||2017-02-23||Bulletin||Provider Assurance Statement for Telemedicine, Minnesota Health Care Programs (MHCP) and Commercial products, requirements, Prepaid Medical Assistance Program (PMAP), MinnesotaCare, Minnesota Senior Health Options (MSHO), Minnesota Senior Care Plus, UCare Connect (SNBC), UCare Connect + Medicare, Fairview UCare Choices, UCare Choices|
|UCare Online Submission of Claim Reconsideration Requests Delayed||2019-03-04||Bulletin||PCRF, online claims form,alert, delay,|
|Provider FAQs – New UCare Claims System||2019-02-12||Bulletin||Claims system, claims platform, FAQs, Individual & Family Plans, Individual and Family Plans, IFP, Inpatient Psychiatric Facility IPF, Inpatient Rehabilitation Facility IRF, Chemical Dependency, eligibility, QHP, 270/271, member ID, Rejects, Rejections, Clearinghouse, clearing house, edits, 55413, 52629, adjudication, PMAP, Prepaid Medical Assistance Program, 277ca, Payer ID, Payor ID, Facility Location Add Form, authorization suspension, requirements, NDC, FDA, taxonomy, 835, EOP, Evidence of Payment, Carc, Rarc, two payments, two checks, provider data, demographics, legacy|
|Updates on Member Eligibility Services for 2019 Individual & Family Plan Members||2019-01-14||Bulletin||Updates on member eligibility services for 2019 Individual & Family members, status, IFP, UCare Choices. Fairview UCare Choices, Interactive Voice Response IVR, 270/271 HIPPA, new member ID format|
|Billing Reminders for Home Infusion Services||2019-01-15||Bulletin||Minnesota MN Health Care Programs MCHP billing guidelines. home infusion services, span calendar month, invalid billing of services|
|CES Facility Editor LCD Implementation||2017-12-19||Bulletin||UCare implemented Medicare Facility LCD/NCD policy edits, Outpatient Facility claims, CMS policy, auto adjudication rate of claims, third party software, Medicare Facility claims, CARC 96, 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), RARC N115, inappropriate coding relationships, CARC 11, RARC N115, inappropriate doagnosstics coding|
|Unauthorized Provider Services||2017-12-20||Bulletin||unauthorized provider services; Minnesota Statute §62Q.556, unauthorized provider services, network benefit levels, non-participating provider services and In-Network Benefits; Loop2310C - NM109, payment to non-participating providers, Minnesota statute §62Q.75, Non-Disclosure Agreements, potential contracting opportunities, Provider Claim Reconsideration Request Form, Section 13 of the statute, appeal requestarbitration|
|Critical Business Reminders||2017-12-15||Bulletin||Quality Program; Pharmacy; formularies and exception process, Prior Authorization criteria, Quantity Level Limits, Minnesota Uniform Form for Prescription Prior Authorizations (PA) Requests and Formulary Exceptions, Clinical Practice Guidelines; Quality Improvement Advisory and Credentialing Council (QIACC), Asthma, Diagnosis and Management, Diabetes, Type 2; Diagnosis and Management, Heart Failure in Adults, Obesity for Adults; Prevention and Management, Prenatal Care Preventive Services for Adults, Preventive Services for Children and Adolescents, behavioral health clinical practice guidelines Assessment and Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder, Assessment and Treatment of Children and Adolescents with Depressive Disorders, Treatment of Patients with Major Depressive Disorder, Treatment of Patients with Schizophrenia, Treatment of Patients with Substance Use Disorders; Complex Case Management Referral Process, screening, Exchange; Utilization Management, Me|
|Basaglar Preferred Long Acting Insulin for MHCP Formulary||2018-02-15||Bulletin||Basaglar Preferred Long Acting Insulin for Minnesota Health Care Programs Formulary – Effective April 1, 2018|
|Behavioral Health Retro Authorization Process Change||2016-03-11||Bulletin||Effective April 15, 2016, UCare will only accept the adjustment/recoupment request form for retro authorization requests.|
|Provider Manual Update||2017-02-14||Bulletin||2017 Provider Manual updates, UCare Connect + Medicare, Delegated Business Services, specialty pharmacy, Claims Reconsideration Form, Claim Appeals Process, “Balanced Billing, Telemedicine, Electronic Data Interchange (EDI), Behavioral Health, Federally Qualified Health Center (FQHC)/Rural Health Clinic (RHC), Transportation|
|December 2017 health lines||2017-12-15||health lines||UCare 2018 benefit change summary, UCare for Seniors, EssentiaCare, State Public Programs, UCare Choices and Fairview UCare Choices, member rights responsibilities, HIPAA verification, PAC, Model of Care training for UCare's MSHO, UCare Connect+Medicare, 2017 Provider Manual December update, Health Outcomes Survey: falls prevention and monitoring physical activity, documentation for yearly evaluation|
|July 2017 health lines||2017-07-14||health lines||prior authorization forms for Elderly Waiver, genetic testing and personal care assistant providers, Genetic Testing Prior Authorization Form, Medicare pricing software for MSHO and Connect + Medicare, CMS Ruling on continuous glucose monitors, therapeutic CGMs, MLN Matters article MM10013, Documentation Improvement: Arrhythmias, Cervical Cancer Screening webinar,American Cancer Society, MIPS estimator, Quality Payment Program (QPP), Stratis Health, high blood pressure, cholesterol education, regular monitoring|
|UCare to Introduce Online Submission of Provider Claims Reconsideration Form||2019-01-17||Bulletin||online Claims Reconsideration Form, requests for adjustment, appeals, recoupments, provider claim reconsideration form|
|October 2017 health lines||2017-10-15||health lines||Mark Traynor UCare President and CEO, General Prior Authorization Requests and Pre-Determination Requests (Medicare only), non-residential medication-assisted treatment, methadone HCPC code H0020, CMS 1500, 837P electronic equivalent, DHS MHCP Provider Manual, real-time Part D vaccine claims, TransactRx, current DEA #, NPI # and Medical License #, POC Technologies, Model of Care training for UCare's MSHO, UCare Connect+Medicare, credentialing with UCare, Revised Minnesota Uniform Credentialing Applications for initial and reappointmen, Disclosure questions (attestation) and authorization and release signatures for both credentialing and reappointment applications, ApplySmart (MCC), October breast cancer screening, documentation for breast cancer|
|September 2017 health lines||2017-09-15||health lines||CMS Interim Rate Letters, Model of Care training for UCare's MSHO, UCare Connect+Medicare, Child Teen Checkup update, periodicity schedule, American Academy of Pediatrics, Bright Futures, the U.S. Preventive Services Task Force, Minnesota Community Measurement guidelines, UCare’s 270/271 HIPAA transaction update, UCare’s Plan IDs and Group Numbers, Provider Assistance Center PAC, HPV vaccinations and STD screenings, documentation for hypertension, member rewards incentives, Colorectal Cancer Screening, Diabetes Care, Mammogram, free car seats criteria|
|Updates to SPP Mental Health Services Claim Processes||2018-03-01||Bulletin||Notice of updates to UCare’s Minnesota State Public Programs mental health services claims processes|
|February 2018 health lines||2018-02-15||health lines||UCare clinical and behavioral health expertise, new drugs and prior authorization, member information accuracy, dental benefits, billing for Qualified Medicare Beneficiaries (QMB) program, copayments cost sharing for Minnesota Health Care Programs members, documentation for amputation status|
|January 2018 health lines||2018-01-16||health lines||Preventive Services for Children and Adolescents clinical practice guideline, provider demographic information, Part D vaccine administration fees, tobacco cessation partner, UCare and third-party biller contracts, UCare for Seniors recognition, new dental goals, basic documentation|
|March 2018 health lines||2018-03-15||health lines||In-home health risk assessment (HRA) service, March colon cancer screening awareness, forms for updating practitioner data, UCare to cover Medicare Diabetes Prevention Program services, dental benefits, documentation improvement for chronic kidney disease|
|Changes to UCare Claims Payment Schedule||2018-04-05||Bulletin||second payment cycle each week on Wednesdays and Fridays.|
|Code and Editing Updates Reminder||2018-12-14||Bulletin||Code and Editing Updates Reminder, UCare automated claims editing and pricing applications, UCare’s Provider Manual, Claims Chapter|
|UCare Provider Manual Has Been Updated||2019-02-28||Bulletin|
|Updates on 2019 Claim Rejection Edits||2019-01-15||Bulletin||Updates on Claim Rejection Edits, zero (0) units code edit, UN qualifier, 277ca, zero anesthesia minutes edits, MJ qualifier, Rejection Edits Affecting Individual & Family IFP Plans ONLY, payor, payer ID, UCare Choices, Fairview UCare Choices, 55413 A3:33:40 subscriber member ID not found, acknowledgement/returned as unprocessed claim, resubmit payor payer ID 52629, A:21:40 missing or invalid information, legacy ID 11-digit, workgroup for electronic data interchange (WEDI), Strategic National Implementation Process (SNIP) Validation|
|March 2017 health lines||2017-03-23||health lines||Expand MnCare & Medical Assistance services in Minnesota, Prepaid Medical Assistance Program (PMAP) and MinnesotaCare, Taxonomy code requirements for claims payments, professional and facility claims, National Plan and Provider Enumeration System (NPPES), error category of A6, error code 145, submitting laboratory tests modifier replaced, State Public Program members, modifier -59, Claim Reconsideration Request Form, Adjustment/Recoupment Request Form, Health Outcomes Survey, Improving or maintaining mental health, UCare for Seniors and MSHO, mistake an older adult’s symptoms of depression as a natural reaction to illness, Documentation improvement: Focus on "history of", office visit examples, Practitioner's rights,credentialing process|
|May 2017 health lines||2017-05-15||health lines||Transition resources for expansion, Prepaid Medical Assistance Program (PMAP,)MinnesotaCare, Provider self-service options, UCare Provider Portal, Interactive Voice Recognition, 270/271 Eligibility and Benefits inquiries, 276/277 Claim Status, UCare's MSHO Model of Care trainings for providers, Health Outcomes Survey, Improving bladder control, improving or maintaining their mental and physical health, Behavioral Health practitioners, Medicare, Outpatient Psychiatry, Psychology Services, Documentation improvement: Focus on COPD ,chronic lung disease,s Medicare Advantage plans waive the SNF 3-Day Rule, Medicare Advantage plan, UCare for Seniors or EssentiaCare|
|Ambulance PPS||2017-01-17||Bulletin||ambulance providers, Medicare pricing tool, UCare for Seniors and EssentiaCare, Pickup Location ZIP Code Required, ANSI X12N Implementation, 837P – Professional (CMS-1500), Loop 2310E, 837I – Institutional (UB04), Loop 2300,clearinghouses, 277CA reports, error category of A6, error code 763|
|Taxonomy Update||2017-02-09||Bulletin||taxonomy codes requirements, professional claims, facility claims, NPIs, National Plan and Provider Enumeration System (NPPES), Centers for Medicare and Medicaid Services (CMS), 277CA reports, error category of A6, error code 145, Healthcare Provider Taxonomy Code Set (HPTC), National Uniform Claim Committee (NUCC), 837P or CMS 1500, 837I, MLN Matters (MM9659)|
|Behavioral Health Update||2017-05-01||Bulletin||Authorizations/notification, billing, behavioral health services, Pre-Paid Medical Assistance Program (PMAP), MinnesotaCare members, Department of Human Services (DHS) Medical Assistance benefit, MN DHS - MHCP Provider Manual- Chapter 16, Minnesota Health Care Programs (MHCP), Mental Health-Targeted Case Management (MH-TCM),Assertive Community Treatment (ACT), Crisis Management, S9484, 90839, 90840, Medication-Assisted Treatment (MAT), Chemical Dependency CD Assessment, H0001, Mental Health Travel Time, chemical dependency CD treatment, transitioned members, CD Notice of Admission and Outpatient Request Form, National Provider Identifier NPI, Taxonomy Required, Billing for Intensive Residential Service, Children’s Mental Health Residential Treatment Authorization and Billing Requirements, Intensive Outpatient IOP Services, MN Statute 256B.0625, Provider Portal Administrator, NPI changes, add/change/remove practitioners, replacement claim, corrected claim, Provider (2010AA Loop), Member (2010CA Loop), Payer (|
|Taxonomy Cross Over Claims||2017-05-30||Bulletin||COB, Medicare crossover claims, eport taxonomy, billing and rendering/attending NPI,clearinghouses, 277CA reports|
|Mark Traynor Named UCare President and CEO||2017-10-11||Bulletin||Mark Traynor, current Interim President and CEO, UCare President and CEO, former Senior Vice President of Provider Relations and Chief Legal Officer, before UCare withMinnesota Attorney General’s Office, Minnesota Department of Human Services.|
|PCA Service Updates||2015-12-10||Bulletin|
|Real Time Part D Vaccine Claims||2017-10-15||Bulletin||Part D vaccine claims, TransactRx, submitting, electronicall, same copay, time of service, Pharmacy Benefit Manager (PBM), POC Technologies, DEA, OIG,|
|Update to UFS Supplemental Vision||2015-12-30||Bulletin|
|Tips & Reminders Regarding Nursing Facility Liability Letters||2018-12-06||Bulletin||Nursing facility liability letters, 100 Day Skilled Nursing Facility/Nursing Facility UCare Connect, UCare COnnect + Medicare, 180 Day Skilled Nursing Facility/Nursing Facility, Minnesota Senior Care Plus, MSC+, Minnesota Senior Health Options MSHO, Minnesota departmern of humna services DHS, Timely Filing Policy, Nursing Facility Communication Form (DHS 4461), Medicaid RUGS Resource Utilization Group|
|CD RES Treatment Room and Board Billing Update||2015-02-27||Bulletin|
|Modifier 59 and New Companion Situational Modifier||2015-02-09||Bulletin|
|UCare to Implement Home and Community-Based Services Billing Changes||2018-06-29||Bulletin||Minnesota Health Care Programs (MHCP), claims processing, Home and Community-Based Services (HCBS) claims, service on a separate line, single date billing requirement|
|Updates on 2019 IFP Claim Payments & Electronic Transactions||2019-01-29||Bulletin||Updates on 2019 Claim Payments & Electronic Transactions, claims submissions, UCare Individual & Family Plans, IFP with Fairview, former UCare Choices, former Fairview UCare Choices, new claims system platform, electronic transactions, Explanation of Payment (EOP), CARCs, RARCs, legacy claims system, provider tax ID number, ACH payments/checks, UCare’s Provider Portal, provider demographic updates, 277ca Claims Acknowledgement Report response messages, 270/271 Benefit & and Eligibility transactions, Interactive Voice Response IVR|
|April 2018 health lines||2018-04-15||health lines||New Behavioral Health prior authorization forms, Preventive Services for Pediatric and Adolescents CPG approved, Mental Health payment policies, CPT codes for Rezūm® system, Health Outcome Survey (HOS), Dental benefits, Model of Care Training, documentation for Chronic Respiratory Disease|
|For Coders and Billers: Billing for Part B Vaccines and Immunizations||2018-08-27||Bulletin||Billing for Part B Vaccines, Immunizations, HCPCS series G0008, G0009 G0010, vaccine or immunization, Medicare Part B vaccines, modifiers, NCCI edit, 90472 or 90474 subsequent admission codes|
|PPS Implementation Follow Up||2017-04-26||Bulletin||Medicare Pricing Software, UCare for Seniors and EssentiaCare, Multiple Procedure Payment Reductions (MPPR),Automated Multi-Channel Chemistry (AMCC) and Panel Tests, Section 90.2 and 90.3 of Chapter 16 of the Medicare Claims Processing Manual, Automated Test Listing (ATP), MPPR for Endoscopy, High Rate, Base Code Rate, bilateral procedures, Per Section 40.7 of Chapter 12 of the Medicare Claims Processing Manual, modifier -50, modifier –RT,|
|June 2018 health lines||2018-06-04||health lines||refreshed UCare brand, Medicare changes to Cost Plans coming in 2019, Finding accurate information from member ID cards, screening adults in day care for TB, UCare Duluth open house, dental connection, documentation for stroke, and our website tip of the month,|
|Revised - UCare Explanation of Payments (EOP) Report and EDI 835 Updates||2018-06-28||Bulletin||Explanation of Payments EOP Report Update, claim payment breakdown Claim Charge, the Payer Payor Adjustment Amount, Patient Responsibility, Claim Payment and Other Contract Obligation fields, Patient Costshare details, EDI 835 Electronic Remittance Advice ERA, Claim Line Level Adjustments|
|February 2019 heath lines||2019-02-06||health lines||enhanced prior authorization DME/Supply form, PA durable medical equipment, supply prior authorization; paper claims submission changes effective March 1, 2019, electronic claims forms, updated submitting claims with unlisted CPT update, RARC code M127, missing patient medical record for this service, CARC 163, attachment/other documentation referenced on the claim was not received, professional CMS1500 - Loop 2400 SV101-07, Facility UB04 - Loop 2400 SV202-07, provider directory directories updates, provider search tool updates, UCare to introduce online claim reconsideration submission; new case management programs for PMAP and MinnesotaCare MNCare Integrated Case Management (ICM) program, Medication Assisted Treatment (MAT) Protocol, Prepaid Medical Assistance Program PMAP, Accurate Member Information is key to smoother claims submissions, unique ID number, HIPPA, clinical documentation of obesity, BMI|
|July 2018 health lines||2018-07-02||health lines||clinical service utilization review survey, mental health payment polices and diagnostic codes, model of care training, documentation improvement for drug/alcohol use, colon cancer screening partnership and patient story, how to find electronic data interchange (EDI) resources|
|2019 EDI Claims Delays for UCare Individual & Family Plans ONLY||2018-12-27||Bulletin||2019 Electronic Data Interchange (EDI) claims delays for UCare Individual & Family Plans, IFP, UCare Individual & Family Plans with Fairview, new payer ID, payor ID, dates of service on or after Jan 10, 2019, 2018 climas unaffected|
|December 2018 health lines||2018-12-03||health lines||UCare's Salute to Excellence, HEDIS Healthcare effectiveness data information sets, Authorization & Notification Grids, Julie Joseph-DiCaprio, Chief Medical Officer, Jeri Peters Chief Nursing Officer, prior authorization, Medicare Cost Plan, accurate member information, member ID number, insurance information, Model of Care Training, MSHO Minnesota Senior Health Option, UCare Connect+ Medicare, zero unit/minutes billing, UCare, submitting unlisted codes, CARC 16 claim/service lacks information or has submission/billing error, RACR M79 missing information, invalid charge, Alliance of Community Health Plans, unlisted CPT, HCPCS codes professional CMS1500 - Loop 2400 SV101-07, Facility UB04 - Loop 2400 SV202-07, diagnosis capture, Holiday Hours, and Crosswalk tip UCare For Seniors, renamed UCare Medicare Plans. UCare Choices renamed Individual & Family Plans IFP, Fairview UCare Choices, MNsure, renamed UCare Individual & Family Plans with Fairview.|
|UCare Renames Three Products for 2019||2018-10-17||Bulletin||UCare For Seniors renamed UCare Medicare Plans. UCare Choices, available through MNsure, renamed UCare Individual & Family Plans IFP, Fairview UCare Choices, available through MNsure, will be renamed UCare Individual & Family Plans with Fairview.|
|January 2019 health lines||2019-01-03||health lines||billing changes to PCA, HCN services servicing members under age 65, personal care assistance PCA, home care nursing HCN, annual assessment, Fee for Service FFS, KEPRO Authorization, UCare Renames three products in 2019, UCare for Seniors, UCare Medicare Plans, UCare Choices, UCare Individual & Family Plans IFP, Fairview UCare Choices, UCare Individual & Family Plans IFP, 2019 Opioid Edits, misuse epidemic, opioid naive patients, long acting opioid, Medicaid and health exchange opioid quantity limits, milligram equivalents (MME), drug management program, The Comprehensive Additional and Recovery Act of 2016 (CARA), Medicare Part D, enhanced prior authorization DME/Supply form, durable medical equipment. supply prior authorization, pre-determination requests, myocardial infarction (MI), heart attack, codes, ST elevation, STEMI, non-ST Elevation NSTEMI|
|Additional Enrollment Opportunities for Medicare Members||2019-01-07||Bulletin||Special Enrollment Period (SEP) Medicare Advantage Open Enrollment Period, enroll, disenrollment, stay original Medicare without Plan D, Medicare Advantage, prescriptions drug plan. enrollment period starts one month later|
|NPI Edit Error Impacting Atypical Providers with Availity||2019-01-15||Bulletin||NPI Edit Error Impacting Atypical Providers with Availity, MISSING BILLING PROVIDER NPI, error for billing without an NPI|
|2019 Pharmacy Formulary Update||2018-12-05||Bulletin||pharmacy formulary changes, 2019 Opioid edits, centers for Medicare Medicaid service CMS, opioid misuse epidemic, safety edits, UCare Medicare plan, Medicaid, Health Exchange plans, IFP, opioid naive patients, long acting opioid, formulary quantity limits, milligram equivalents (MME), high risk medications HRM elderly, Hepatitis C Virus MCV, Diabetic testing|
|Jan. 1, 2019, Changes for PCA & HCN Providers Serving Members Under Age 65||2018-12-11||Bulletin||billing changes to PCA, HCN services servicing members under age 65, personal care assistance PCA, home care nursing HCN, annual assessment, Minnesota Health Care Program MHCP, Department of Human Services DHS, member counties, tribes, PCA service agreements, PCA Technical Change request, DHS-4074A, Disability Services Division (DSD) Resources Center, HCN service agreements, Fee for Service (FFS), Home Care Technical Change Request DHS-4074, MN-ITS, KEPRO,|
|New UCare Claims Payment Schedule effective July 23, 2018, and forward||2018-07-12||Bulletin||restart second payment cycle each week effective July 23, 2018, remite payments|
|2018 Authorization and Notification Grids Available||2017-11-15||Letter||2018 authorization and notification requirements, product offerings include: EssentiaCare, MinnesotaCare, Minnesota Senior Care Plus (MSC+), Minnesota Senior Health Options (MSHO), Prepaid Medical Assistance Program (PMAP), UCare Connect, UCare Connect + Medicare, UCare for Seniors (UFS), UCare Choices and Fairview UCare Choices. Updates include: Home Health Aids & Skilled Nurse Visits of 15 visits per calendar year; Acupuncture of 20 visits per calendar year. This is not a Medicare covered benefit. Vagus Nerve and Vein Procedures need authorization prior to service, Vein Procedures, Deep Brain Stimulation and Hysterectomy no longer needs Prior Authorization. Behavioral Health Changes|
|Home Care Provider Authorization Changes||2016-01-06||Bulletin||Frequently Asked Questions about Authorization Changes. Each year, UCare evaluates past year’s performance, authorization data, approval/denial rates and provider and member satisfaction survey result. A notification does not require a clinical review and clinical documentation does not need to accompany the documentation.|
|Part D Provider Enrollment Requirement||2016-01-19||Bulletin||The Centers for Medicare & Medicaid Services (CMS) recently updated a new rule that that requires any physician or other eligible professional who prescribes Part D drugs to enroll in the Medicare program or opt out of receiving Medicare reimbursement in order to prescribe drugs to patients with Part D prescription drug benefit plans.|
|Transportation Provider Provider Manual Updates||2015-12-04||Bulletin|
|April 2015 health lines||2015-04-13||health lines|
|August 2015 health lines||2015-08-18||health lines|
|December 2015 health lines||2015-12-15||health lines|
|February 2015 health lines||2015-02-19||health lines|
|January 2015 health lines||2015-01-15||health lines|
|June 2015 health lines||2015-06-15||health lines|
|March 2015 health lines||2015-03-15||health lines|
|May 2015 health lines||2015-05-15||health lines|
|November 2015 health lines||2015-11-15||health lines|
|October 2015 health lines||2015-10-15||health lines|
|September 2015 health lines||2015-09-15||health lines|
|ICD-10 DSM5 Behavioral Health||2015-08-18||Bulletin|
|UCare Choices Claims Submission Changes for 2019||2018-10-24||Bulletin||New Payor Payer ID 55413, Individual & Family Plans. IFP, UCare Choices and Fairview UCare Choices plans, electronic claims clearinghouse, EDI, 2018 Payor ID 52629, New member ID and format, 300000000 member, 01, spouse, 02 dependents, new claims system platform|
|ARHMS Authorization Update||2016-06-01||Bulletin||Each year, UCare reviews our notification and authorization requirements and makes adjustments to our authorization grids based on industry trends, member utilization and cost of specific services. As result of this review, UCare intended to require prior authorization on all Adult Rehabilitative Mental Health Services (ARMHS) beginning Jan. 1, 2016.|
|April 2017 health lines||2017-04-19||health lines||MnCare & Medical Assistance services in Minnesota, Prepaid Medical Assistance Program (PMAP) and MinnesotaCare, Taxonomy code requirements for claims payments, professional and facility claims, National Plan and Provider Enumeration System (NPPES), error category of A6, error code 145, medical and behavioral health utilization criteria, medical necessity hierarchy, clinical decision support tools, published criteria, Medicare, Dual integrated, State & Pubic programs, Exchnge, behavioral health, McKesson InterQual, UCare's Medication Therapy Management program, drug therapy problems, cost-saving opportunities, Sexually Transmitted Infections, STI annual testing day, Community Restoring Urban Youth Health (CRUSH), CRUSH’s STI Testing Day, annual wellness exams, Documentation improvement: focus on quality documentation|
|June 2017 health lines||2017-06-15||health lines||prior authorization forms for Elderly Waiver, genetic testing and personal care assistant providers, Genetic Testing Prior Authorization Form, Taxonomy code on crossover claim, billing and rendering/attending NPI, Provider Assurance Statement for Telemedicine, Minnesota Health Care Program (MHCP), Commercial, Antidepressant Medication Management and Follow-up after Hospitalization improvement projects, Prepaid Medical Assistance Program and MinnesotaCare Antidepressant Medication Management (AMM) PIP, UCare for Seniors, Minnesota Senior Health Options (MSHO) and Minnesota Senior Care Plus (MSC+) AMM QIP, UCare Connect Follow-Up after Hospitalization (FUH) PIP, Provider Toolkit, Twin Cities Mobile Market, Submitting medical record documentation, 200 DPI setting, Depression in older adults webinar, Senior Matters – Depression in Older Adults, National Alliance on Mental Illness (NAMI), Documentation improvement: Common diagnosis coding errors|
|Payment Delay||2016-04-22||Bulletin||After identifying the system issue, UCare determined that this one day delay was necessary to minimize rework and impact to provider accounts receivable processing.|
|Provider Manual Update Transportation Section||2015-01-16||Bulletin|
|FQHC-RHC Payment Carve-Out Process||2015-07-30||FAQs|
|UFS Vision FAQs||2015-07-28||FAQs|
|Vision Benefit Routine Screening Eye Examinations||2015-05-11||Bulletin|
|FQHC-RHC Update to ANSI Code Grid||2015-10-08||Bulletin|
|Vision ICD-10 Important Information||2015-09-30||Bulletin|
|May 2018 health lines||2018-05-15||health lines||Features of the updated UCare.org/providers website, use add-on codes and buddy system, submitting claims with unlisted procedure codes, state public programs with dental coverage, documentation focus on acute vs. chronic|
|April 30, 2018 Provider Manual Update||2018-04-30||Bulletin||UCare's Provider Manual critical information for providers to work with UCare members. reference regularly for up-to-date content. The Provider Manual has been updated to reflect current business practices. Updated Working with UCare's Delegated Business Services, Provider Credentialing, Claims & Payment, Electronic Data Interchange, Clinical Practice Guidelines, Health Promotions Programs, Obstetrics & Gynecology|
|April 2016 health lines||2016-04-12||health lines||UCare and Fairview Intent to Combine Health Care Expertise, Change in Provider Assistance Center Hours, Sign Up to Have UCare Provider News Delivered to Your Email, UCare Provider Portal, Nominations Open for UCare's Excellence in Cultural Care & Disabilities Care Clinic Award, April is STD Awareness Month, CMS Delays Enforcement of Part D Provider Enrollment Requirements, Documentation Improvement: Focus on Malnutrition|
|August 2016 health lines||2016-08-12||health lines||Share Your Feedback in the Provider Services Survey, New Board Certification Requirements for Credentialed Providers, Welcome Back UCare Mobile Dental Clinic, Documentation Improvement: Focus on Coding and Reporting, Prescription Drug Monitoring Program Registration Requirement|
|February 2016 health lines||2016-02-11||health lines||UCare Products for 2016, Payment Date Added through February 29, 2016, Documentation Improvement: Focus on Stroke, 2016 HEDIS Season, Elderly Waiver Updates, Unused Units of Elderly Waiver Services Cannot Be Carried, Advanced Directives Reminders|
|January 2016 health lines||2016-01-19||health lines||UCare Products for 2016, Changes to UCare Claims Payment Schedule, Therapy Providers: Health Services Management Inc. is Now Magellan Health Care, Attention All Prescribers: Provider Enrollment Requirements for Writing Medicare Prescriptions, Effective Jan. 1, 2016, A Child & Teen Check-up(C & TC) Referral Code is Required When Billing C&TC Services, Documentation Improvement: Focus on Correct Condition Definitions (Acute vs. Chronic vs. Acute on Chronic), Webinar: Behavoral Health Care for Refugees: Barriers, Best Practices and Cultural Humility|
|July 2016 health lines||2016-07-14||health lines||Have You Notified UCare About Third-Party Agreements? A Salute to Excellence! Event Honors Health Care Providers, Avoid Claim Payment Delays and Denials for Unlisted Drugs, UCare's MSHO Model of Care Training for Providers, Documentation Improvement: Focus on Yearly Evaluation, Chiropractic Care Offers Patients with Lower Back Pain an Option for Pain Relief, Webinar: Behavoral Health Care for Refugees Series, Results from 2015 Medical Records Standards Audit, Diagnostic Testing for Zika Virus|
|June 2016 health lines||2016-06-14||health lines||Notification No Longer Required for Orthopedic Procedures, UCare Offering Convenient Screening Options for Osteoporosis, Documentation Improvement: Focus on Specificity, Provider Manual Ch. 17 Has Been Updated, Changes to Affect Elderly Waiver Program Effective July 1, UCare Connect Service Area to Expand July 1, Sign Up to Have UCare Provider News Delivered to Your Email|
|March 2016 health lines||2016-03-16||health lines||Michael Ruiz Joins UCare as Vice President of Provider Relations & Contracting, MAFP Spring Refresher, April 14-15: See you ther, Documentation Improvement: Focus on Listse! Reminder: Weekly Payment Cycle, Use of Unlisted CPT or HCPCS Codes, New in 2016: Helping UCare Members to Quit Smoking Got a Little Easier, HOS and CAHPS Surveys On the Way, UCare Products for 2016|
|May 2016 health lines||2016-05-11||health lines||UCare Connect Service Area Expansion, UCare Welcomes New Chief Medical Officer, Facility Closing: 60 Day Advance Notice Process, UCare Adds Providers Who Must Be Credentialed, UCare's MSHO Model of Care Training, Documentation Improvement: Focus on Chronic Kidney Disease, UCare Partners with Wellshare International to Close Gap in Care, Behavioral Health Care for Refugees Webinar Series, 2016 Minnesota Elder Abuse Awareness Day Conference|
|October 2016 health lines||2016-10-18||health lines||Introducing Connect + Medicare, UCare's New Behavioral Health Prior Authorization Fax Number, Results from 2016 Medical Records Standards Audit, Antidepressant Medication Performance Improvement Project Update, Documentation Improvement: Focus on Obesity|
|September 2016 health lines||2016-09-15||health lines||Continuity of Care and Utilization Review Survey Now Open, Options for Verifying Member Eligibility and Benefits, A Transition of UCare's Behavioral Health Authorization Program, Document Improvement: Focus on Major Depression|
|December 2016 health lines||2016-12-15||health lines||UCare Holiday Hours,2017 Auth Grids Available, Prior Authorization Reminder, Did You Know: You can verify claims status 24/7? Documentation Improvement: Risk Adjustment, Critical Business, Member Rights and Responsibilities Reminders|
|November 2016 health lines||2016-11-16||health lines||Summary of UCare Health Care Plan Benefit Changes for 2017, Facility Closing: 30 Day Advance Notice Process, Follow up After Hospitalization for Mental Illness Performance Improvement Project Update, Medicare Plan Highly Rated in Two National Quality Assessments, Advanced Directives Reminders, Clinical Practice Guidelines, RxMentor Member Website, Documentation Improvement: Focus on Diagnosis, Keep Important News Coming to Your Inbox|
|August 2018 health lines||2018-08-01||health lines||The Clinical Utilization Survey starts this week! the Keep Your Coverage program, CMS Rate Letter options, a new provider search tool for members, documentation information for malnutrition, and how to find Authorization Forms on our website. Medicare 2019 changes cost plans|
|September 2018 health lines||2018-09-05||health lines||UCare online resources for all providers; our tobacco quit line; Protected Health Information reminders; clinical documentation for cancer; and website tips for Child & Teen check-ups. Medicare 2019 changes cost plans|
|Important Drug Recall Information||2018-07-30||Bulletin||Drug Recall Information, Valsartan, heart failure, high blood pressure, FDA, nitrosodimenthylamine (HDMA)|
|New Drug Prior Authorization Removals Beginning July 1, 2018||2018-06-22||Bulletin||July 2018 Drug Prior Authorization Removals, Botulinum Toxins (Botox, Dysport, Myobloc, and Xeomin); Immune Globulins (Privigen, Gammagard, Carimune, Gamunex, Hizentra, Bivigam, Gammaplex, Vivaglobin, Octagam, Flebogamma, Glebogamma, HyQvia, Immune Globulin NOS); Viscosupplementation Knee Injections (Gel-One, Hyalgan, Orthovisc, Supartz); Remicade; Prolia: Prior Authorization will only be required for UCare Medicare plans, Pharmacy Therapeutics Committee|
|New Provider Search Tool for Members||2018-07-23||Bulletin||Provider Search Tool, home, place, pharmacies, compare distance to provider, ucare.org|
|All UCare Providers: Critical Business Reminders (new template)||2018-07-25||Bulletin||Critical Business Reminders, Credentialing and Recredentialing Processes, Provider Credentialing (Practioners' Rights), Pharmacy, formularies, list of covered drugs, exceptions, electronic prior authorizations ePA, Express Scripts, Sure Scripts, Coveredmeds, Electronic health record, Minnesota Uniform Form for Prescription Drug Prior Authorization (PA) Requests and Formulary Exceptions, Drug Coverage Determination Form, generic substitution, Minnesota Statute 151.21, Complex Case Management, Utilization Management, Medical Necessity Criteria Request Form, Member Rights and Responsibilities, Disease Management Information, Asthma, Diabetes, Heart Failure|
|New State Public Program (SPP) Medical Drug Prior Authorization Request Form effective September 1, 2018||2018-08-03||Bulletin||New State Public Programs (SPP) medical drug prior authorization request form, new fax number and Injectable Drug, UCare Connect, Minnesota Senior Care Plus, MinnesotaCare, Prepaid Medical Assistance program, Families and Children|
|Provider Manual Updated||2018-01-31||Bulletin||Key updates include: Delegated Business Services preferred pharmacy network for UCare for Seniors members is Express Scripts’ electronic prior authorizations (ePA) with phone and fax numbers; nondiscrimination policy, Claims chapter updates include Vaccines Covered by Medicare Part D; Notifying UCare of Contracts with Third-Party Billers; Coding Appeals; Unlisted Codes; LCD/NCD Updates; and Unauthorized Provider Services; Electronic Data Interchange (EDI) section updated contact information for RelayHealth and taxonomy code requirements; Authorizations and Notifications section updated; Disease Management Programs; Fraud, Waste and Abuse section; Well Child Care Coding for Quality Measurement and Payment; UCare’s Smoking and Tobacco Cessation Programs.|
|Billing for Mental Health and Chemical Dependency Services||2018-06-01||Bulletin||Billing for mental health and chemical dependency services, consolidated chemical dependency treatment fund CCDTF, fee schedule, HCPC codes, modifiers|
|October 2018 health lines||2018-10-03||health lines||UCare directory and subdirectory updates, accurate member information tips, cost estimate request forms, model of care training, documentation improvement for vascular disease and the results for the Clinical Services Utilization Survey. Medicare 2019 changes cost plans|
|November 2018 health lines||2018-11-05||health lines||2019 UCare Health Care Plan Benefit Changes, UCare Medicare plan, UCare Total, UCare Complete, Bayfield, Douglas and Washburn, Fairview Health Services and North Memorial Health are launching a new Medicare Advantage HMO-POS, State Public Programs benefit changes for 2019, UCare Individual & Family Plan, Medicare Cost Plan Changes, Dr. Julia Joseph-DiCaprio, Dan Santos, Claims Processing Updates for Telemedicine, MM10583. CARC 5, RARC 77, CARC 4, RARC 77, QIACC, Behavioral Health clinical practice guidelines, Year-End Provider Contract Updates, Confidentiality of Substance Use Disorder Patient Records, 2019 Opioid and 2019 Formulary Updates, Hepatitis C Virus (HCV), Congestive Heart Failure CHF documentation, Delta Dental of Minnesota Network Update, CivicSmiles|
|UCare to Suspend Authorizations in 2019 for UCare Choices Plans||2018-11-01||Bulletin||UCare suspend the PA prior authorization requirement, UCare Choices, Fairview UCare Choices, Individual & Family Plans, UCare Individual & Family Plans with Fairview, IFP, prior authorization, medical services, behavioral health services, provider-administered drugs for 2019. Notification requirements, medical necessity criteria|
|FAQs - Suspension of Authorizations For UCare Choices and Fairview UCare Choices Members Effective Jan. 1, 2019||2018-11-01||FAQs||frequently asked questions, FAQ , suspension prior authorization UCare Choices, Fairview UCare Choices, Individual & Family Plans, UCare Individual & Family Plans with Fairview, IFP, retro-authorizations, claim reconsiderations 2018, system upgrades, Notification requirements, medical necessity criteria, benefit exception process, prior authorization, medical services, behavioral health services, provider-administered drugs for 2019.|
|UCare Announces Changes Affecting Claims Editing for UCare Choices Plans Beginning Jan. 1, 2019||2018-11-29||Bulletin||Claims editing for UCare Choices Individual & Family Plans IFP, Fairview UCare Choices, UCare Individual & Family Plans with Fairview, claims submission, claims submission platform, workgroup for electronic data interchange (WEDI), Strategic National Implementation Process (SNIP) Validation, SNIP 1-5, Ambulance pick-up/drop off locations, admission date, taxonomy code, custom edits, CE plus Zero/Minutes, Optum Claims Editing System™ (CES) Optum Prospective Payment System™ (PPS), Skilled Nursing Facility SNF, Inpatient Psychiatric Facilities IPF, Inpatient Rehabilitation Facilities IRF|