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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
ABN FAQs 2015-12-28 FAQs
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
Mid-level Reduction 2015-12-21 Bulletin
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,
Taxonomy 2015-12-01 Bulletin
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
NDC 2015-02-26 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
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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
Vision Clarification 2015-04-16 Bulletin
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.
UCare ABNs 2015-01-26 Bulletin
FQHC-RHC 2015-01-30 Bulletin
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
FQHC-RHC 2015-03-03 Bulletin
Transportation 2015-03-25 Bulletin
State_Immunization_Changes 2015-05-27 Bulletin
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

UCare Provider Manual 2019 Update

The Provider Manual has been updated to reflect current business practices. UCare has prepared a Provider Bulletin outlining the key updates.

Read the bulletin.