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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
October 2019 Health Lines 2019-10-07 Newsletter Accurate Member Information, subscriber ID, claim submission matches / Release of Information, in-network provider, patient medical records, Provider Participation Agreement / Medicare Nursing Home Claims Payments, Nursing Home Report Card, Minnesota Senior Care Plus (MSC+), Minnesota Senior Health Options (MSHO), Connect and Connect+Medicare, CARC CO163: Attachment/other documentation referenced on the claim was not received, SNF rate information, Submit an appeal / Medicare Annual Wellness Visits, Annual Wellness Visit (AWV), Health Risk Assessment, HCC diagnoses, primary care / Transition to PDPM for SNF Claims, Patient Driven Payment Model Methodology, Interim Payment Assessment (IPA), Assessment Reference Date (ARD) / Documentation Improvement: Current and Historical Conditions, History of
CORRECTION: Coding Changes for Adults and Children's Mental Health Crisis Response Services for UCare State Public Programs Products 2019-10-07 Bulletin October Health Lines, HCPCS S9484, HCPCS H2011, billing grid, 90882
UCare Provides Individual & Family and Medicare Members with COVID-19 Financial Relief 2020-05-28 Bulletin IFP, telehealth, Medicare, primary care, PCP, waiver copays, waive coinsurance, waive deductible, member premiums July August, medical supplies, snacks, infrastructure grants, duration of federal and state public health emergencies, COVID-19, coronavirus.
Change in Frequency for Outpatient Hospital Fee Schedule Updates 2020-12-15 Bulletin Prepaid Medical Assistance Program (PMAP), UCare Minnesota Care (MNCare), UCare Minnesota Senior Care Plus (MSC+) and UCare Connect (SNBC, Medicaid Only), MHCP Outpatient Fee Schedule
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
Medicaid Nutritional Supplement Benefit Change 2019-03-29 Bulletin Boost, Ensure, Medical nutrition, Minnesota Senior Care Plus, UCare Connect, Prepaid Medical Assistance Plan, MinnesotaCare, DHS Provider Manual, coverage criteria, Durable Medical Equipment (DME) provider, Oral enteral nutritional products
UCare to Introduce Online Submission of Claim Reconsideration Requests May 20 for Adjustments/Appeals and Recoupments 2019-05-15 Bulletn online submission Provider Claim Reconsideration Form, Provider Portal Users, Non-Provider Portal Users,
Behavioral Health Claims Updates 2019-05-23 Bulletin Consolidated Chemical Dependency Treatment Fund Claims, Mental Health Targeted Case Management Claims, of Consolidated Chemical Dependency Treatment Fund CCDTF, MH-TCM, Minnesota Medical Assistance
UCare Online Submission of Claim Reconsideration Requests Delayed 2019-03-04 Bulletin PCRF, online claims form,alert, delay,
Inhaler Preferred Drug List Status Changes 2019-09-06 Bulletin Advair Diskus non-preferred, Wixela Inhub, Dulera, Symbicort, Ventolin HFA non-preferred , Albuterol Sulfate HFA (Prasco Manufacturer), Proair, Proventil, UCare Connect (SNBC), MinnesotaCare, Prepaid Medical Assistance Program (PMAP) and Minnesota Senior Care Plus (MSC+), Proactive review and treatment adjustments
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
Partial Hospitalization Claims Update Being Implemented at Clearinghouse Level 2019-09-16 Bulletin procedure code H0035, clearinghouse level, SPP, IFP, State Public Program, Individual & Family Plans, more than one unit of service, Partial Hospitalization services
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
MinnesotaCare Tax Changing Jan. 1, 2020 2019-11-13 Bulletin MinnesotaCare Tax, provider reimbursement, Minn. Stat. § 295.52
UCare’s “A Salute to Excellence!” Celebrates 22 Health Care Providers 2019-10-16 Bulletin 11th annual, performance delivering high-quality care to UCare’s Medicare, Medicaid and Special Needs Plan members.
Temporary Suspension of Medicare Claim Processing Edits 2020-07-21 Bulletin
New Prior Authorization Requirement for Victoza and Nubeqa 2021-01-15 Bulletin
Additional Claims Payment Run Added for May 2020 Holiday Week 2020-05-21 Bulletin claims payment run, remit, clam status
Changes to the Payment and Remittance Selection Process 2020-12-18 Bulletin request Electronic Fund Transfer (EFT) and Electronic Remittance Advice (ERA) changes was removed, require the prior financial institution, UCare Contract Manager
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
August 2016 health lines 2016-08-12 Newsletter 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
Transition to Patient Driven Payment Model Methodology 2019-09-27 Bulletin Patient Driven Payment Model (PDPM), Health Insurance Prospective Payment System (HIPPS) code, Interim Payment Assessment (IPA), Assessment Reference Date (ARD), Skilled Nursing facilities, SNF
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.
UCare Announces Changes Affecting Claims Submissions for UCare Medicare Plans Beginning Jan. 1, 2020 2019-10-30 Bulletin Claim submissions, UCare Medicare Plans, new claims system, new payor id, 2020 claims, 55413, Functional Receiver Group Header ID GS03, UCAREMN, Interchange Receiver Control Header ISA08, ISA07, ZZ, clearinghouse, UCare Medicare, EssentiaCare and UCare Medicare with M Health Fairview & North Memorial, Electronic Data Interchange, Provider Manual, Member ID card, 9-digit, 9 digit, taxonomy, payer id, payor ID, ifp, individual and family plans
Provider Assurance Statement for Telemedicine Required to Deliver Telemedicine Services to Certain UCare Members 2019-12-12 Bulletin Prepaid Medical Assistance Program, PMAP, MinnesotaCare, MNCare, Minnesota Senior Health Options, MSHO, Minnesota Senior Care Plus, MSC+, UCare Connect, UCare Connect + Medicare, UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview, IFP, Provider Assurance Statement for Telemedicine, CARC: 163, RARC: N59, UCare telemedicine policy
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
February 2016 health lines 2016-02-11 Newsletter 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
Billing Requirements for Medicare Certified Home Health Care and ESRD Providers 2019-11-14 Bulletin End-Stage Renal Disease, ESRD, submit claims, UCare Medicare Plans, UCare Medicare with M Health Fairview & North Memorial, Minnesota Senior Health Options, MSHO, UCare Connect + Medicare, UCare Individual & Family Plans and UCare Individual & M Health Fairview, IFP.
June 2019 Health Lines 2019-06-03 Newsletter Temporary Increase in COB Reprocessing, Provider FAQ: New Claims System, Psychiatric Assistance Line (PAL), and PAC Holiday Hours
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
SNF Pricing Tool Implementation 2016-09-30 Bulletin
November 2019 Health Lines 2019-11-05 Newsletter 2020 Health Plan Benefits, UCare Medicare Plan benefits, TruHearing, Healthy Savings OTC, Mom's meals, acupuncture, State Public Programs benefits, Housing Syabilization services, Individiual & Famiy Plans, tiered drugs, updated PAC Phone Message, Portal Access to Medicare Part D Appeal and Ineligible Provider List, CMS/DHS Billing Requirements for the 340B Drug Pricing Program, -UD, -JG, -TB, 2019 Q4 Provider Manual Update, Documentation Improvement for Status Codes, Cervical Screening Webinar, Model of Care Annual Training, MOC, Hoiday Hours, PAC, Provider Assistance Center
Hospital Interim Claims Billing 2019-11-14 Bulletin Final Bill for Long-term Hospitalization must Include Appropriate Bill Type, claims for long stay inpatient cases,
2020 Changes to Medical Benefit Drug Prior Authorizations 2019-11-15 Bulletin Care Continuum, Express Scripts, initiate prior authorization requests with Care Continuum, medical drugs requiring prior authorization, summary of Medical Injectable Drug prior authorization changes for 2020, Biosimilar step therapy for medical drugs in 2020
UCare to Implement New Transportation Management Software in 2020 2019-10-10 Bulletin Transportation system delay, Health Ride, HealthRide, NEMT, non emergency medical transportation, TripSpark, NovusMED, Novus MED, software, driver and vehicle fleet information, roster submissions
Pharmacy Formulary and Benefit Changes for 2020 2019-11-20 Bulletin 2020 UCare pharmacy formulary changes, 2019 formulary, 2020 formulary updates, UCare Medicare, EssentiaCare, UCare Medicare with M Health Fairview & North Memorial, UCare Medicare Group Plans, Minnesota Senior Care Plus, MSC+, Minnesota Senior Health Options, MSHO, UCare Connect, UCare Connect+Medicare, Prepaid Medical Assistance Program, PMAP, Individual & Family Plans, Individual & Family Plans with M Health Fairview, 2020 IFP copay plans, 2020 IFP high deductible health plans, insulin monthly cap, $25 monthly copay cap, insulin prescription, insulin covered, short-acting insulin, intermediate-acting insulin, long-acting insulin, Basaglar Kwikpen, Novolin Flexpen, Novolin vial, Novolog Flexpen, Novolog vial, Novolog Penfill cartridge, 2020 formulary additions, removals, alternatives
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
Off-campus Provider-based Hospital Department Services 2019-11-22 Bulletin UCare State Plans, off-campus provider-based hospital department services, PBD, Modifier -PO, Modifier -PN, Hospital Part B services, excepted claim lines
UCare to Align Claims Processing with SUD Reform for HF Modifier 2019-06-24 Bulletin Substance Use Disorder SUD, Minnesota Department of Human Services (DHS), HF modifier with code H0001, Comprehensive Assessment – H0001, Rule 25 Assessment – H0001 with HF modifier, Prepaid Medical Assistance Program, MinnesotaCare, UCare Connect, UCare Connect + Medicare, Minnesota Senior Health Options and Minnesota Senior Care Plus plans.
December 2019 Health Lines 2019-12-02 Newsletter New Payor ID for UCare Medicare Plans, Payor ID 55412, 9-digit Member ID, UCare Medicare, EssentiaCare and renamed UCare Medicare with M Health Fairview & North Memorial Health, Care Continuum and Drug Prior Authorization Reviews, Online ePA, ExpressPAth Portal, medical benefit drugs list, 2020 Formularies and Benefits Changes, Insulin Benefit, Individual & Family Plan, IFP, copay cap, insulin prescription filled, Amy Christensen, Vice President of Clinical Services, VP CLS, Behavioral Health Survey, survey results, Behavioral Health Triage & Case Management, UCare’s Behavioral Health Triage Phone, crisis Intervention, Behavioral Health Referrals, Behavioral Health Case Management Consultation. Behavioral Health Provider In-Network and Specialty Search, Behavioral Health Service Authorization and Notifications, Identification and Connection to Community Resources, TruHearing Hearing Aid Benefit, TruHearing network, MnCare Tax Change, MinnesotaCare Tax, Gender Identity Information Form, Documentation Improvem
January 2016 health lines 2016-01-19 Newsletter 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 Newsletter 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 Newsletter 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
FAQ: Temporary Suspension of Medicare Claim Processing Edits 2020-07-21 Bulletin
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
Potential Delay in Issuance of Some 2020 UCare Medicare ID Cards 2019-12-23 Bulletin Delay ID cards. Identification cards. Letter to members. Proof of coverage. Check eligibility. 9-digit member IDs. Nine digit member IDs, 9 digit member IDs.270/271, 270 271, HIPAA Transaction, interactive voice response (IVR). Provider Portal. Medicare.
UCare Provider Manual Has Been Updated 2019-02-28 Bulletin
May 2019 health lines 2019-05-01 Newsletter UCare Provider Manual Q2 Update, contracted providers, Provider FAQ: New Claims System, Individual & Family Plans, IFP, April 2019 update, MHCP Drug List Changes, pharmacist, patient letter June 1, DHS preferred drug list, Accurate Member Information, subscriber ID care, unique member ID, Documentation Improvement for Aortic Aneurysm, thoracic, abdominal, UCare & Health Fair 11 Bike Safety Event, May 11, 2019, KARE 11 studios, bike helmet clinic, ages 4-14, Provider assistance center closed Memorial Monday, May 27, provider portal for assistance
Provider FAQs – New UCare Claims System 2019-04-02 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
August 2019 Health Lines 2019-08-05 Newsletter Jennifer J. Garber, our new Associate VP of Behavioral Health, behavioral health equity, Q3 Provider Manual Update, Partial Hospitalization Claims, per session, MN-ITA 837-I, Code 0912 or 0913, H0035, 13X (Outpatient) or 76X (CMHC), Documentation for Metastatic Cancer, secondary, and SNF PPS Changes from CMS, Patient Driven Payment Model, PDPM, agreement amendment.
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
April 2020 Health Lines 2020-04-06 Newsletter Message from UCare CEO Mark Traynor, COVID-19 Information For Providers, Clinical Practice Guidelines, FAQ, Clinical Practice Guidelines, Hyperactivity, ADHD, Depression, Schizophrenia, Substance Use Disorder, SUD, Expedited Appeals for Pharmacy and Medical Drugs, formulary exceptions, Mental Health and Substance Use Disorder Team, Accurate Member Information, Documentation Improvement for Dementia
September 2019 Health Lines 2019-09-04 Newsletter HCBS billing requirement reminder, T1016, T2028 CDCS, T2041 CDCS mandatory case management, alternative care and elderly waiver, PANDAS and PANS pediatric autoimmune coverage requirements, D89.89, SNF CMS Methodology Change, PDPM Amendment. and Documentation for Bipolar Disorder.
Minnesota Health Care Programs Drug List Changes Coming Effective July 1, 2019 2019-06-04 Bulletin Preferred Drug List, PDL, Prepaid Medical Assistance Program, MinnesotaCare, Minnesota Senior Care Plus and UCare Connect, Department of Human Services DHS, Non- preferred drugs need prior authorization
2015 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
2018 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
March 2016 health lines 2016-03-16 Newsletter 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
UCare Provider Manual Has Been Updated 2020-02-28 Bulletin 2020 Provider Manual, current business practices, Claims, delegated services, Electronic Data Interchange EDI, Authorizations and Notifications, Medical Necessity Guidelines, Fraud waste abuse, health promotions, Home care services, PCA, obstetrics gynecology, obgyn, pregnancy nurse line
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
UCare ABNs 2015-01-26 Bulletin Discontinue use of Advance Beneficiary Notice of Non-coverage (ABN) or an ABN-like form, CMS bulletin May 5, 2014, Improper Use of Advance Notices of Non-coverage., chapter 5 of the 2014 Provider Manual, Medicare Advantage Plans inform member
FQHC-RHC 2015-01-30 Bulletin “encounter” payments to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), Minnesota Health Care Programs (MHCP), MDH 256B.0625, not apply to claims for members who are eligible for Medicare, Remittance Advice (RA), RA 835, a Provider-Based Biller, no change to the initial claim submission
January 2020 Health Lines 2020-01-07 Newsletter new claims system, payor ID 55413, UCare Medicare Plans, EssentiaCare, UCare Medicare with M Health and North Memorial Health, 2020 member ID cards, Medicare, member letter, UCare 270/271, IVR, Provider Portal, type of authorization number format, S######, $S0000######, 0000######, A, H=OT/PT/ST, R=UCare Individual & Family Plans, IFP, S=Services, DME, claim reconsideration form, Inpatient Hospital Readmission Payment Policy, Provider Center, Network Resources, Join Our Network, Manage Your Information, Credentialing, Provider Search, provider website, BH, behavioral health Survey 2019, areas of improvement, implemented interventions, Case Management, member centric advocacy, mental health, substance use, social determinant needs, Prepaid Medical Assistance Plan, PMAP, Minnesota Care, MnCare, Minnesota Senior Health Options, MSHO, Minnesota Senior Care Plus, MSC+, Behavioral Health Case Management referral form, Behavioral Health Triage Phone Line, Ineligible Provider List, Provider Inquiries, food insecu
UCare Announces Changes Affecting Claims Editing for UCare Medicare Plans and State Public Programs Beginning Jan. 1, 2020 2019-11-25 Bulletin Expanded SNIP edits. Any claim that does not pass the Workgroup for Electronic Data Interchange (WEDI) Strategic National Implementation Process (SNIP) validation will reject, and providers will have to fix the billing error and resubmit a new claim submission.Additional 2020 edits (including 2019 edits). Attending Provider Name is required for any services other than non-scheduled transportation claims, Ambulance pick up/drop off location is required, Diagnosis code has already been used, All industry standard codes (CPT, HCPCS, revenue, diagnosis, taxonomy, zip code, etc.) are valid and active on the date of service, Zero Units/Minutes will not be accepted, EPSDT condition indicator ‘NU’ to be used when there is no referral given, Other subscriber Name ID qualifier must be equal ti ‘MI’, The claim level adjustments CAS cannot be equal to zero
PCA Service Updates 2015-12-10 Bulletin two six-month date spans, authorized hours/units, Units cannot be transferred, hours/units cannot be added, 256B.0659.
Additional Billing Guidance for Medicare Certified Home Health Care Providers 2020-05-01 Bulletin claims, billing guidelines, payment methodology, Patient-Driven Groupings Model (PDGM), continuous care episodes, 60-day episode of care, 30-day period of care, claims submission instructions, CMS Billing Resources, UCare Medicare Plans, UCare Medicare with M Health Fairview & North Memorial, Minnesota Senior Health Options (MSHO), UCare Connect + Medicare, UCare Individual & Family Plans, UCare Individual & Family Plans with M Health Fairview, IFP
FDA Recall of Certain Manufacturers of Metformin Extended-Release Tablets 2020-06-11 Bulletin Metformin Extended Release, Metformin ER tablets, N-Nitrosodimethylamine (NDMA), Amneal and Apotex, Actavis (Teva) and Marksans Pharma Limited, type 2 diabetes, FDA news release, members be switched to other manufacturer, letter to members
Taxonomy Update 2017-02-09 Bulletin
Mid-level Reduction 2015-12-21 Bulletin Mid-level Reduction, master’s level prepared mental health providers, Minnesota Health Care Program (MHCP), Clinical Nurse Specialist (CNS), Licensed Independent Social Workers (LICSW), Marriage and Family Therapists, licensed (LMFT), Nurse Practitioners (see note above), Professional Clinical Counselors, licensed (LPCC), Psychological Counselors (LPC), Community Mental Health Center
Reminder for Billing Services From Indian Health Services or 638 Facilities 2019-05-08 Bulletin Minnesota Department of Human Services, DHS, Indian Health Services, IHS, 638 facility, MinnesotaCare, Minnesota Senior Care Plus, Minnesota Senior Health Options (Medical Assistance services only), Prepaid Medical Assistance Program, Families and Children, UCare Connect (SNBC), UCare Connect + Medicare (Medical Assistance services only), state responsibility, MHCP Provider Manual, IHS/638 claims
September 2020 Health Lines 2020-09-10 Newsletter ICD-10-CM Coding for Social Determinants of Health, Z codes, food, housing, transportation, education, violence, social support, health behaviors and employment; UCare Members to Receive In-Home Test Kits, microalbumin, A1c, colorectal cancer screenings, BioIQ, no extra cost; 2020 Formulary Status for Influenza Treatments, State Medical Assistance Programs, Oseltamivir capsules, Oseltamivir suspension, Tamiflu capsules, Tamiflu suspension, Relenza, Xofluza; Ineligible Provider List Updated 08/31/2020, MHP, Mental Health, Chemical Dependency; September is Falls Prevention Awareness Month, 1 in 3 adults 65 or older, fear of falling,; Adult Residential Intensity: High Intensity Committed/Complex Reminder, state public program patients, high intensity committed/complex modifier, H2036 & TG, U4, HK; Provider Relief Fund Application Deadline Extended to Sept. 13, $15 billion to eligible providers who had not yet received a payment, CARES Act Provider Relief Fund; Model of Care Training, Minnesota
Taxonomy 2015-12-01 Bulletin professional and facility claims, Accredited Standards Committee (ASC) X-12 837, Technical Report Type 3,
Provider Manual Update Transportation Section 2015-01-16 Bulletin Carve out, FAQ, UCare Minnesota Senior Health Options (MSHO), UCare Minnesota Senior Care Plus (MSC+). UCare Connect (Special Needs Basic Care), Medicare, CARC 31, Patient/Subscriber Loop, Patient/Dependent Loop, 2300/NTE02, 2300/REF02, UCare’s RA/835, CARC code of ‘16’ and a RARC code of ‘N463, S0280 and S0281
Vision ICD-10 Important Information 2015-09-30 Bulletin UCare for Seniors Supplemental Vision Benefit: ICD-9 to ICD-10 codes, ICD-9 Code V72.0, September 2015, ICD-10 Code, Z01.00, Z01.01
Update to UFS Supplemental Vision 2015-12-30 Bulletin
May 2016 health lines 2016-05-11 Newsletter 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
UCare Temporarily Changes Post-Acute Care Authorization And Notification Requirements 2020-04-20 Bulletin prior authorization and notification requirements, Coronavirus (COVID-19), post-acute care, 48 hours of admission, Skilled Nursing Facility & Swing Bed Admission, UCare Medicare, EssentiaCare, UCare Medicare with M Health Fairview and North Memorial, MSHO, UCare Connect + Medicare, Long-Term Acute Care Hospital SNF, Long-Term Acute Care Hospital, LTAC, Acute Inpatient Rehab, Home Health Care (Skilled nurse visits, Home Health Aide), UCare Connect, UCare Connect + Medicare
2019 Critical Business Reminders 2019-07-30 Bulletin credentialing, recredentialing, formularies, pharmaceutical procedures, clinical restrictions, prior authorizations, PA, step therapy, ePA, Express Scritps, CoverMyMeds, Statute 151-21, predictive modeling, screening, Medicare, Individual and Family Plans, IFP, Exchange members, Important Coverage Information, medical necessity criteria rquest form, antidepressant medication management shard decision making tool, SDM tool, Mayo clniic, CPG, Preventive Services for Children and Adolescents, Diabetes in Adults, Type 2 Diagnosis & Management. member rights
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 Chemical dependency providers: CD Room & Board services update, no longer be reimbursing the room and board, DHS Alcohol & Drug Abuse Division released CCDTF E-MEMO #14-09 on 5/19/14, billing chemical dependency residential claims, charges per CCDT, Rev Codes 1002 or 1003, Bulletin 7/16/14 reiterating the messages
NDC 2015-02-26 Bulletin National Drug Code, NDC, Minnesota Health Care Programs, DHS expanded health plan encounter reporting, drug quantity, dosage, number of units, Examples of EOP descriptions regarding NDC claims, inappropriately recouped claim payments, AUC standard, CARC 16, RARC M123, RARC M119
Modifier 59 and New Companion Situational Modifier 2015-02-09 Bulletin The -59 Modifier and X(EPSU) Modifiers – Effective January 1, 2015, for all UCare products, -XE Separate Encounter, -XS Separate Structure,-XP Separate Practitioner, -XU Unusual, Non-Overlapping Service, Medicare guidelines
UCare Pharmacy COVID-19 Update 2020-03-26 Bulletin Coronavirus, access to medication, refills, prescriptions, options, monitoring treatments, clinical trials, drug shortages, formulary status
December 2016 health lines 2016-12-15 Newsletter UCare Holiday Hours, 2017 Auth Grids Available, Prior Authorization Reminder, Summary of UCare health care plan benefit changes for 2017, claims status 24/7? Documentation Improvement: Risk Adjustment, Critical Business Reminders, Member Rights and Responsibiliities
November 2016 health lines 2016-11-16 Newsletter 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, Hospital Discharge Planners, Medicare Plan Highly Rated in Two National Quality Assessments, Advanced Directives Reminders, health care directive, Clinical Practice Guidelines, Asthma, Diabetes, RxMentor Member Website, Documentational Improvement: Focus on Diagnosis,
2016 Critical Business Reminders 2016-12-14 Bulletin Credentialing and Recredentialing Process, Pharmacy, The Complex Case Management Referral Process, Utilization Management Information, UM Coverage decisions, Medical Necessity Criteria, Member Rights and Responsibilities, Shared Decision Making , Clinical Practice Guidelines, asthma. diabetes, heart failure, preventive services child and adolescent Adults type 2, diagnosis and management, Critical Business Reminders, Provider Manual, Practitioner Rights
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, T1016 case management, T2028 consumer-directed community supports (CDCS), T2041 CDCS mandatory case management (alternative care and elderly waiver)
Pharmacy Access – Disruption Due to Protests 2020-05-29 Bulletin pharmacies disrupted, transportation disrupted, common questions, open pharmacies, coverage for medication, delivery
New Medicare Products to Offer Supplemental Coverage for Nebulizer and Pulse Oximeters 2020-12-22 Bulletin supplemental coverage for nebulizer and pulse oximeters, no authorization or prior face-to-face visit required, Genevive, care coordinator , diagnosis code to include on the claim when billing, COPD CODE J44.0, J44.1, J44.9, CHF CODES 150.20, 150.21, 150.22, 150.23, 150.30, 150.31 150.32, 150.33, 150.40, 150.41, 150.42, 150.43, 150.81, 150.9
Notification Requirements Update: Outpatient SUD Services 2020-06-05 Bulletin individual/group (H2035),treatment coordination (T1016 U8 HN), peer recovery support (H0038 U8), Prepaid Medical Assistance Program (PMAP), MinnesotaCare, Minnesota Senior Health Options (MSHO), Minnesota Senior Care Plus (MSC+), UCare Connect, UCare Connect + Medicare, UCare Individual & Family Plans, and UCare Individual & Family Plans with M Health Fairview (H2035 and T1016 U8. Notification of Substance Use Disorder (SUD) Outpatient
Medicaid & CHIP Provider Relief Fund Distribution Update 2020-07-29 Bulletin Medicaid, CHIP, Children's Health Insurance Program, provider application, distribution, eligible providers, Provider Relief Fund Distribution Update , COVID-29 coronavirus, General Distribution, fact sheet, FAQ, Cares Act
ARMHS Provider Notification/Change Request Form Updated 2020-09-29 Bulletin Provider Information, Behavioral Health Services, Adult Rehabilitative Mental Health Services (ARMHS), Mental Health and Substance Use Disorder Services team
Notification Requirements Update: Adult Rehabilitative Mental Health Services (ARMHS) 2020-07-01 Bulletin Adult Rehabilitative Mental Health Services, ARMHS, H2017, Basic living and social skills, 90882, Environmental or community intervention, H0031, Mental health assessment, H0032, Mental health services plan development, ARMHS Provider Change Request, prior authorization, PA, Mental Health and Substance Use Disorder Services
Coronavirus (COVID-19) Information for Providers 2020-03-20 Bulletin Coronavirus, COVID-19, Information for Providers, FAQ, Frequently asked questions, member questions
UCare to Roll Out New Member ID Card Design 2020-06-15 Bulletin Member ID Card Tip Sheet, new cards, replacement cards, 2021 for all members, two sided, card issued date, coverage year, copayments for services, coinsurance, copays, provider portal
August 2020 Health Lines 2020-08-04 Newsletter UCare Provider Manual Update, Restricted Recipient, Provider Credentialing, Claims Payments, Authorizations Notifications, Medical Necessity Criteria for Services Requiring Authorization, Mental Health and Substance Use Disorder Services, Hospital Services, Transportation, Holiday Closure Hours, Labor Day, PAC, New Member ID Card Design, new members, replacement cards, Rheumatoid Arthritis, LivingWell Kid Kits, Medicaid Youth, age under 18, fitness run kit, youth de-stress kit, child dental kit, Tween/Teen Dental Kit, Member Rights and Responsibilities, Provider Relief Fund Application Deadline Update, August 28, extension.
Coordination of Benefits Reporting Updated on Remits 2020-08-26 Bulletin After hearing from providers, UCare is pleased to announce an enhancement to our EOPs and 835s. This week, UCare will update the reporting of COB claims on EOPs and 835s. UCare will now be reporting prior payments/adjustment amounts in the CAS segment with OA (Other Adjustment) 23 (The impact of prior payer(s) adjudication including payment and/or adjustments). Prior payments, adjustment amounts, CAS, segment, OA, other adjustment, 23, CO, Contractual obligation,
February 2020 Health Lines 2020-02-06 Newsletter 2020 Medical Drug Prior Authorizations, Care Continuum, ExpressPAth Portal, Express Scripts,Medical Drug Policies Ineligible Provider List January 24 Update; Claims for UCare Medicare Plans, Payor ID 55413, UCare Medicare with M Health Fairview & North Memorial Health, 9-digit Member ID; Tobacco and Nicotine Cessation Outreach, Quit for Life, NRT starter kit, outreach calls, tobacco or nicotine use, PMAP, MNCare, UCare Connect and UCare Connect+Medicare members; Preventing Falls for UCare Medicare Members, Strong & Stable Kit, UCare’s MSHO or MSC+ members, Theraband,, SilverSneakers, Balance Builder; Pregnant and Postpartum, ROSEBUD program, Kubra Dire, UCare’s Perinatal Outreach Specialist, UCare’s perinatal outreach, pregnancy risk assessment; Documentation Improvement forThrombocytosis, thrombocythaemia, excess thrombocytes, platelets, UCare’s Behavioral Health Triage line, Behavioral Health Case Mangement, Care Management Referral Form
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
Important Admission Notification Reminders 2020-08-06 Bulletin Acute care hospital: Inpatient Admission. Observation status admissions, Maternity/Newborns, Intermediate levels of care: Long-term Acute Care Hospital (LTACH), Acute Inpatient Rehabilitation facility (AIR)
Temporary Rate Increase for Personal Care Assistance (PCA) and Elderly Waiver (EW) Consumer Directed Community Supports (CDCS) 2020-12-16 Bulletin suspend application of the “lesser of” contract provision, PCA rate increase of 8.4% for services provided from Dec. 1, 2020, until the later of Feb. 7, 2021, 8.4% rate increase for all EW CDCS claims.
March 2020 Health Lines 2020-03-02 Newsletter U Health & Learning Express mobile service, U Health & Learning Express mobile service, Carver County, Community Paramedic home visit programs Fairview Health System, North Memorial Health, Crisis Funding, Open Cities Health Center in St. Paul, Postpartum depression support group, Duluth, Hennepin County’s Project Child, health equity, Dakota County, Medication Assisted Treatment, mental health services to underserved and inmate populations, Ramsey County, Scott County, Washington County Jail, Mental health, Allina Health, Health equity training, Children’s Minnesota, Park Nicollet, Justice, Anoka County, Housing and wellbeing fund for homeless, at-risk individuals, St. Louis County, Twin Cities Mobile Market, Wilder Foundation, Immigrant health, Somali Circles of Health & Wellbeing program in Minneapolis and Rochester, Portico Healthnet, Somali Community Resettlement program, Olmsted County, Lutheran Social Service Senior Companion Services, Thriving Minds and Healthy Aging initiative Carlton County, notifi
UCare Introduces Enhanced Prior Authorization and Pre-Determination Forms for Medical Services and Medical Injectable Drugs 2020-05-29 Bulletin General Prior authorization, predetermination, Medicare, July 1 effective date, medical services, medical injectable drug
UCare Introduces New and Updated Mental Health and Substance Use Disorders Prior Authorization and Notification Request Forms 2020-05-29 Bulletin Mental Health Inpatient and Residential, Mental Health Outpatient , Psychiatric Residential Treatment Facility (PRTF), Institution for Mental Disease (IMD), Early Intensive Development and Behavioral Intervention (EIDBI), Substance Use Disorder Inpatient and Residential, Substance Use Disorder Outpatient, Mental Health and Substance Use Disorder Out-of-Network. notice of admission form, prior authorization, PA, Psychiatric Residential Treatment Facilities (PRTF), Institution for Mental Health Disease (IMD), July 1 effective
FAQs on New ARMHS Notification Requirement 2020-08-28 FAQs Adult Rehabilitative Mental Health Services (ARMHS) – Frequently Asked Questions ARMHS notification intake NPI ongoing services
UCare Modifies Authorization Requirements for CTSS Thresholds and SUD Inpatient Admission and Residential Treatment Services 2019-10-25 Bulletin authorization requirements for Children’s Therapeutic Services and Support (CTSS) thresholds and Substance Use Disorder (SUD) inpatient admission and residential treatment services DHS unit conversion changes to H0031 and H0032. H2014, H2015, H2019, H0031 and H0032 new unit counter SUD inpatient admissions and residential treatment was changed to require notification within 24 hours of admission/intake Behavioral Health Services and include the Rule 25 Assessment, Comprehensive Assessment and/or Placement Summary.
January 2021 Health Lines 2021-01-04 Newsletter MH-SUD Access Line, Mental Health and Substance Use Disorder, mental health, substance use and social factor needs, Triage Line, referrals, post-payment review delayed, paid date on or after Sept. 1, 2020, coverage policy for Individual and Family Plans (IFP) - Coverage CP-IFP20-001A, CP-IFP20-002A, CP-IFP20-003A, CP-IFP20-004A, CP-IFP20-005A, CP-MCD20-006A, reimbursed by UCare for face-to-face interpreting time, UCare Foundation has awarded more than 15 grants throughout Minnesota for health improvement initiatives, a young person with disabilities transitions to an adult health plan and potentially different providers, COVID-19 Information for Providers, Authorizations, Billing and Payment, Telehealth, Telemedicine and Technology Based Services, Child & Teen Check Incentives, 15-month Infant Child & Teen Checkup, 30-month Infant Child & Teen Checkup, 3-21 year Child & Teen Checkup, Kit 1: Fitness Fun Kit, Kit 2: Youth De-stress Kit, Kit 3: Child Dental Kit, Kit 4: Tween/Teen Dental Kit, Over-the-Counter
2019 Off-Campus Provider-Based Hospital Department Services Claims to be Adjusted 2020-04-02 Bulletin billing requirements, reimbursement guidelines, off-campus provider-based hospital department services, CMS Outpatient Prospective Payment System, UCare Medicare, Dual Eligible, Individual & Family Plan, calendar year 2019, reprocess off-campus claims, reimburse payment reductions applied to these services
UCare Introduces New Medicare Supplement Plans 2020-10-08 Bulletin Medicare Supplement, Medicare-eligible, Basic Medicare Supplement, Extended Basic Medicare Supplement, $20/$50 Copay Medicare Supplement, be submitted directly to Medicare, phone support, Medicare Supplement ID card
October 2020 Health Lines 2020-10-07 Newsletter Provider Demographics, supervising provider information, paper claims, 837P format loop 2310D, NN1919, NM102, NM103, NM104, NM108, NM109, Flu Season Reminder, Clinical Practice Guidelines Approved, 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 Schizophrenia, Treatment of Patients with Substance Use Disorders (SUD), UCare Mobile Dental Clinic, UCare Dental Connection, Documentation Improvement: Capturing Chronic Conditions, COVID-19 Information for Providers, authorizations, Billing Payment; relief funding
UCare Medicare Part D Vaccine Information 2020-11-18 Bulletin Part D, CARC 280, RARC N751, Vaccination Provided at a Pharmacy, Vaccination Provided at a Clinic, Express Scripts, TransactRx
Medical Benefit Drug Prior Authorization for 2021 and Biosimilar Step Therapy Information 2020-11-18 Bulletin 2021 UCare formularies, Shingrix, Insulin, Diabetes, Medicare removed, Humalog, Humulin, Dexcom, Advair Diskus, Proair, IFP removed, Venlafaxine ER Tablet, Asmanex Inhaler, Neulasta
Pharmacy Formulary and Benefit Changes for 2021 2020-11-18 Bulletin Medical Benefit Drug Prior Authorization, Care Continuum, retrospective pharmacy authorization, adjustment on an existing prior authorization, UCare Clinical Services, scheduling issues, 150 drugs require authorization in 2021, Biosimilar Step, Enzyme Replacement, Hematology, Hereditary Angioedema, Immunologicals, Infertility, Inflammatory Conditions, Multiple Sclerosis, Oncology, Rare/Miscellaneous Conditions, Pegfilgrastim, Infliximab, Rituximab, Trastuzumab, Filgrastim, Epoetin, Bevacizumab, 365-day lookback for Medicare, 180 day lookback for Medicaid
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
Behavioral Health Update 2017-05-01 Bulletin Authorizations/notification, billing, behavioral health services, Pre-Paid Medical Assistance Program (PMAP), MinnesotaCare members, MN DHS - MHCP Provider Manual- Chapter 16, 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, Alcohol, Drug Abuse, transitioned members, CD Notice of Admission and Outpatient Request Form, National Provider Identifier 10 digit NPI, Taxonomy Required for payment of claims, Billing for Intensive Residential Service, Children’s Mental Health Residential Treatment Authorization and Billing Requirements, Intensive Outpatient IOP Services, MN Statute 256B.0625, NPI changes, add/change/remove practitioners, replacement claim, corrected claim, 2010AA Loop, 2010CA Loop, 2010BB Loop, 2010BA Loop, 2300 DTP Segment
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,
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
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
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.
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,
Taxonomy Cross Over Claims 2017-05-30 Bulletin COB, Medicare crossover claims, eport taxonomy, billing and rendering/attending NPI, clearinghouses, 277CA reports, error category A6, error cod 145
October 2016 health lines 2016-10-18 Newsletter 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 Newsletter 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
2021 Code and Editing Updates 2020-12-29 Bulletin multiple automated claims editing and pricing applications, Claims Edit System (CES) version 5.4, Minnesota Health Care Program Products and its Special Needs Plans, Prospective Payment System
Medication Therapy Management (MTM) Program Update 2020-11-04 Bulletin MTM, Medicaid, Individual and Family Plans (IFP), face-to-face visit or an interactive video (ITV) encounter, Medicare Part D benefits are eligible, in-network pharmacist, prescription, over-the-counter medications and/or herbal supplements, document all encounters electronically, HCFA-1500/837P, Audits, Billing Processes, CPT 99607, CPT 99606, CPT 99605, Continuity of Care Document (CCD) Expectations, Opt-Out Processes
Mark Traynor Named UCare President and CEO 2017-10-11 Bulletin Mark Traynor, UCare President and CEO
April 2017 health lines 2017-04-19 Newsletter 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
August 2017 health lines 2017-08-16 Newsletter 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,
Impact of COVID-19 on Mental Health and Substance Use Disorder (SUD) Practice Webinar 2020-09-10 Bulletin Scott Yarosh, M.D. Mental Health and Substance Use Disorder, MH-SUD, two part webinar, virus, treatments, health care inequities, preexisting psychological symptom, October 2020
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.
April 2015 health lines 2015-04-13 Newsletter
August 2015 health lines 2015-08-18 Newsletter
December 2015 health lines 2015-12-15 Newsletter
February 2015 health lines 2015-02-19 Newsletter
January 2015 health lines 2015-01-15 Newsletter
June 2015 health lines 2015-06-15 Newsletter
March 2015 health lines 2015-03-15 Newsletter
May 2015 health lines 2015-05-15 Newsletter
November 2015 health lines 2015-11-15 Newsletter
Vision Clarification 2015-04-16 Bulletin
October 2015 health lines 2015-10-15 Newsletter
ICD-10 DSM5 Behavioral Health 2015-08-18 Bulletin
September 2015 health lines 2015-09-15 Newsletter
Transportation Provider Provider Manual Updates 2015-12-04 Bulletin County and Volunteer Agencies are exempt, Transportation Service Expectations and Requirements, Health Ride Provider Profile Form, 2015 provider manual, chapter 12
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.
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, 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, error category of A6, error code 145, 277CA report, clearinghouse, the 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
FQHC-RHC Update to ANSI Code Grid 2015-10-08 Bulletin FQHC, RHC, ANSI Grid, CARC, 269, 3, 256, 146, B11, Rarc N913, M47, Voided Claims.
May 2018 health lines 2018-05-15 Newsletter Features of the updated 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
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
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 Newsletter 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
December 2017 health lines 2017-12-15 Newsletter 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
February 2017 health lines 2017-02-15 Newsletter 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
June 2020 Health Lines 2020-06-01 Newsletter Covid-19 Member relief Q&A,coronavirus, Medicare, telehealth, home kits, masks, healthy snack boxes and iPads, COB, explanation of payment, IFP, CO-109-Claim, COVID-19 Information for Provider web page updates, telehealth visits, Complete visit documentation as you would for an in-person visit,, Model of Care, MOC, training, Minnesota Senior Health Options (MSHO), UCare Connect + Medicare plans, Dual Eligible Special Needs Plans, Quit for Life, UCare’s tobacco quit line program, independence day observation.
Market Withdrawal Alert – Ranitidine (Zantac) Products 2020-04-24 Bulletin N-nitrosodimethylamine (NDMA), impurity, igher than room temperatures, risk of cancer, supply shortages for the drug famotidine, cimetidine, nizatidine, omeprazole, pantoprazole and lansoprazole
May 2020 Health Lines 2020-05-06 Newsletter Coronavirus, COVID-19, Billing and Payment, Pharmacy and Formularies, Adding Practitioners/Locations on a Temporary Basis, Credentialing, Telehealth, Prior authorizations, ranitidine (Zantac) drugs on the market, N-nitrosodimethylamine, NDMA, famotidine, nizatidine, cimetidine, omeprazole, pantoprazole, lansoprazole, Adult Rehabilitative Mental Health Services (ARMHS) are rehabilitative services, Minnesota Senior Care Plus (MSC+), Minnesota Senior Health Option (MSHO), UCare Connect, UCare Connect + Medicare, Prepaid Medical Assistance Program (PMAP) or Minnesota Care (MnCare), HEALTH CLUB SAVINGS, Medicare, over the counter benefits, COVID-19 FUNDING, Social isolation, Telehealth, Food insecurity, MATTERbox snack packs, Personal Protective Equipment (PPE), UCare Connect (SNBC), Medical Assistance (MA) and a certified disability, Todd, Wadena and Morrison
November 2020 Health Lines 2020-11-04 Newsletter Summary of UCare Health Care Plan Benefit Changes for 2021, New Medicare Plan Offerings, UCare Prime (South), UCare Aware, EssentiaCare Access, UCare Value Plus, TruHearing, Healthy Savings OTC, Delta Dental, new Institutional Special Needs Plan (I-SNP), Genevive, new Medicare Supplement Plans, UCare Individual & Family Plan Changes, 77 counties across the state, State Public Programs Benefit Changes, COVID-19 Flexibilities, Medicaid-Only Plans, virtuwell eVisits, Dual Eligible Special Needs Plans denal programs, activity, and health tracking tools, weight watchers, memory support kit, caregiver support; UCare's Update About Direct Access and the Parallel Process for Substance Use Disorder (SUD) treatment services, UCare 2020 Provider Manual Update Oct. 14, 2020, UCare's First Virtual "A Salute to Excellence!", UCare Car Seat Distributions During COVID-19, Phase 3 of COVID-19 Provider Relief Funding Available through Nov. 6, 2020, COVID-19 Information for Providers Page Update, Authorization waiver for certa
Code and Editing Updates 2019-12-23 Bulletin new codes, automated claims editing, edit, code, coding. Processing claims. Resubmission, adjustments, incorrect editing of claims. Update implementation dates. Claims Editing System (CES), Prospective Payment System (PPS). Claims adjudication system. IFP claims. Facility edits, professional claims, facility claims. Pricing. December, 2019
December 2020 Health Lines 2020-12-02 Newsletter Pleasant Radford Jr. UCare Health Equity Officer, Individual and Family Plan (IFP), Authorization 2021 Turnaround Time Requirement, Medical Benefit Drug 2021 Prior Authorization, Pharmacy Formulary and Benefit 2021 Changes, Shingrix Coverage for Medicare Plans, Insulin Benefit for Medicare, IFP, Select Brand Diabetes Drugs, UCare Resources for Parents, Caring for Your Baby page, Caring for Your Baby book, Savings on Healthy Food at the Grocery Store, Healthy Savings program, Quality Documentation, Model of Care Training. UCare’s Minnesota Senior Health Options (MSHO) and UCare Connect + Medicare plans, Dual Eligible Special Needs Plans, online training, in person training, UCare Closed, Dec 25-25, 2021 Jan. 1, 2021.
January 2017 health lines 2017-01-17 Newsletter 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
July 2017 health lines 2017-07-14 Newsletter 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
June 2017 health lines 2017-06-15 Newsletter 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
March 2017 health lines 2017-03-23 Newsletter 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 Newsletter 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
November 2017 health l ines 2017-11-15 Newsletter 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
October 2017 health lines 2017-10-15 Newsletter 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 Newsletter 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
February 2018 health lines 2018-02-15 Newsletter 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 Newsletter 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 Newsletter 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
April 2018 health lines 2018-04-15 Newsletter 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
June 2018 health lines 2018-06-04 Newsletter 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,
July 2018 health lines 2018-07-02 Newsletter 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
December 2018 health lines 2018-12-03 Newsletter 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.
August 2018 health lines 2018-08-01 Newsletter 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 Newsletter 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
January 2019 health lines 2019-01-03 Newsletter 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
February 2019 heath lines 2019-02-06 Newsletter 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
April 2019 heath lines 2019-04-04 Newsletter retired medical policies, UCare health equity contributions, HCBS single date billing reminder, Provider FAQs - new UCare claims system, Model of Care annual training, Minnesota Senior Health Options (MSHO), UCare Connect + Medicare, oral health, Dental Connection, UCare Mobile Dental Clinic, billing replacement remarks, T1016, T2028 CDCS, T2041 (alternative care and elderly waiver), brakes for walkers, Claim Level CMS1500 - Loop 2300 NTE01 and NTE02, Service Line Level CMS1500 - Loop 2400 SV101-07 documentation improvement for compression fractures, pathologic fracture, traumatic fracture
March 2019 health lines 2019-03-04 Newsletter Online Submission of the Claim Reconsideration Request Form Delayed, 2019 UCare Provider Manual, Provider FAQs – New UCare Claims System, Healthy Saving Discount Program, Documentation for Deep Vein Thrombosis (DVT)
July 2019 Health Lines 2019-07-08 Newsletter
2020 Critical Business Reminders 2020-08-12 Bulletin practitioner’s rights related to the credentialing and recredentialing processes, pharmacy, complex case management referral process. utilization management information, member rights and responsibilities statement, shared decision-making aids, clinical practice guidelines, social determinants of health
Important Drug Recall Information 2018-07-30 Bulletin Drug Recall Information, Valsartan, heart failure, high blood pressure, FDA, nitrosodimenthylamine (HDMA)
Providers Asked to Verify That They are Using Correct Payor ID for 2019 and 2020 Medicare Claims 2020-02-03 Bulletin claims submission 2020, Payor ID 55413, claims submission 2019, 2019 date of service, DOS Payor ID 52629, UCare Medicare Plans, EssentiaCare, UCare Medicare with M Health Fairview & North Memorial, clkaims denied, member termed, member voided, Medicare Claims
Reinstatement of Previously Suspended Medicare Claims Processing Edits 2020-11-23 Bulletin July 21, 2020 bulletin, Medicare members claims, Part B medical, drug and durable medical equipment (DME) services, process date, new claims, reprocessed claims, replacement claims, adjusted claims and/or void/reinstated claims, previously paid during the suspension may now result in denials of claims
July 2020 Health Lines 2020-07-06 Newsletter Telephonic Outreach, well child exams and immunizations, our Somalian and East Asian populations, Bruce Cantor, M.D., M.S., UCare Medical Director, Temporarily Changes to Post-Acute Care Authorization and Notification Requirements April 20, September, Sept. 30, Skilled Nursing Facility & Swing Bed, Long-Term Acute Care Hospital, Acute Inpatient Rehabilitation, Home Care Services (i.e., skilled nurse, home health aide), prior authorization for out of network services, UM Satisfaction Survey, Ineligible Provider List Updated June 29, 2020, Silver Sneakers, Healthy Savings, UCare Medicare Plans, UCare Medicare w/ M Health Fairview & North Memorial, EssentiaCare, UCare Minnesota Senior Health Options (MSHO), UCare Connect and UCare Connect + Medicare, Life Time Fitness, YMCA Twin Cities, SNAP Fitness, Curves, Healthy Contributions Clubs, National Independent Health Club Association (NIHCA) clubs, UCare member ID number, current insurance information, New Member ID Card Format, two-sided, card issued date, copay
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,
Withdrawal Management Added to Mental Health & Substance Use Disorder Services 2020-04-07 Bulletin Chemical Dependency. Substance Use Disorder, state public programs, Withdrawal Management, Behavioral Health, MN-SUD, BH
FDA Alert on Voluntary Recall of Albuterol Inhalers Manufactured by Perrigo 2020-10-06 Bulletin Perrigo, albuterol inhalers , pharmacy level recall, letters to impacted members, FDA website, switch inhalers, inhaler malfunction,
Coronavirus (COVID-19) Coverage Guidance 2020-03-12 Bulletin HCPCS codes, coverage guidance, COVID-19, coronavirus
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
UCare to Implement New Transportation Management Software in 2019 2019-03-29 Bulletin Transportation Management Software, replace HealthRide application, transportation requests, non-emergency medical transportation, NEMT, TripSpark Technologies, NovusMED, accessible from anywhere, current NEMT driver and vehicle fleet information, roster submissions, transportation technology
Ineligible Provider List Updated August 31, 2020 2020-09-09 Bulletin MHP, Chemical Dependency, Mental HElath, IEP
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 Newsletter 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 Newsletter 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
Providers Asked to Set Up Electronic Payments by Aug. 31, 2019 2019-07-01 Bulletin UCare will no longer issue capitation payments by check effective Sept. 30, 2019. We are asking providers to set up Automated Clearing House (ACH) or electronic payments. To ensure that your payments continue to be processed in a timely manner, please complete and email a Vendor Set Up Form to by Aug. 31, 2019. ACH payments provide both the sender and receiver with the advantages of improved controls, reduced chances for check fraud, better cash management and reduced bank charges. When your payment is made via ACH, funds will be posted to your bank account on the next banking day. Once enrolled in ACH, UCare will send an Electronic Remittance (notification of payment) to the email address provided on the Vendor Setup Form
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
Early Intensive Development and Behavioral Intervention (EIDBI) Claims Payment 2020-12-14 Bulletin service, rendering, billing, QSP. Qualified Supervising Professional, Level I, II or III technician ,

Q4 2020 Update to UCare's Provider Manual

UCare’s 2020 Provider Manual contains critical information that providers need to know to effectively work with UCare and our members. It is important that providers reference the online manual regularly for up-to-date content. The Provider Manual has been updated to reflect current business practices. 

Go to the 2020 Provider Manual page.