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.
UCare has developed a bulletin regarding issues that may cause claim rejection edits.
See the full bulletin.
UCare has identified some additional work required to accurately report member eligibility status for 2019 Individual & Family Plan members in our Interactive Voice Response and our 270/271 HIPAA Transaction. We anticipate 2019 IFP member eligibility should be available in our IVR system by Jan. 18, 2019, and in the 270/271 HIPAA transaction by Jan. 31, 2019. We apologize for this inconvenience. Providers can obtain updated member eligibility status in UCare’s Provider Portal and by contacting the Provider Assistance Center. Member eligibility status is available for all other UCare health plans using the IVR and the 270/271 HIPAA Transaction.
See the full bulletin .
UCare has been alerted that there is an issue with Availity – atypical transportation providers are receiving “...MISSING BILLING PROVIDER NPI” rejection in error for billing without an NPI. Availity has informed us that they have classified this issue as a high priority. We will update this notice as we learn more. Please direct any questions about this issue to Availity. We apologize for the inconvenience.
Medicare-eligible individuals have multiple opportunities to enroll in the most appropriate plan to meet their needs.
We’ve prepared a Provider Bulletin to help explain the following enrollment periods:
In this edition, read about changes for PCA and HCN services billed to members under age 65, new product names, 2019 Opioid Edits, enhanced prior authorization DME/Supply form, and documentation improvement for MI.
In 2019, UCare will transition to a new claims adjudication system for Individual & Family Plans. To allow time to test and ensure all connections are ready for claims processing, UCare is requesting that providers begin sending claims with dates of service in 2019 on or after Jan. 10, 2019, for Individual & Family Plan members ONLY. Claims for 2018 dates of service and all other lines of business are unaffected.
UCare uses multiple automated claims editing and pricing applications to ensure consistent and accurate processing of claims. Please allow appropriate time for the updates to be put into production.
Changes have been announced for Personal Care Assistance (PCA) and Home Care Nursing (HCN) providers who provide services to Minnesota Health Care Program recipients under age 65 who are enrolled with UCare.
UCare has released a bulletin reminding providers about the Nursing Facility Liability Letters process, including liability notification letters, UCare's Timely Filing Policy, and Nursing Facility Communication form (DHS 4461).
Refer to the full bulletin for additional information.
This bulletin provides a summary of the UCare pharmacy formulary changes taking effect Jan. 1, 2019. Plan names have changed for 2019 for Medicare plans and Individual & Family plans.
On Jan. 1, 2019, UCare will make changes that affect claims edits for only UCare Choices and Fairview UCare Choices plans (to be renamed UCare Individual & Family Plans and UCare Individual & Family Plans with Fairview in 2019).
UCare's 2019 authorization and notification requirements are now available on our website at ucare.org/providers, under the Eligibility & Authorization section: State and Federal programs, UCare Medicare Plans, EssentiaCare, Behavioral Health and Pharmacy.
During 2019, UCare will temporarily suspend the requirement for prior authorizations for services delivered to members with UCare Choices and Fairview UCare Choices (renamed as UCare Individual & Family Plans and UCare Individual & Family Plans with Fairview in 2019).
Effective January 1, 2019, UCare will make changes that affect claims submission for only UCare Choices and Fairview UCare Choices plans (to be renamed UCare Individual & Family Plans and UCare Individual & Family Plans with Fairview on January 1, 2019).
UCare informs providers of critical business reminders for NCQA accreditation requirements for Credentialing, Pharmacy, Complex Case Management, Utilization Management, Member Rights and Responsibilities, and Disease Management.
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To find a specific provider communication, use the “Document Name,” “Date Published” or “Communication Type” columns or enter a key word in the search box.
|Document Name||Date Published||Communication Type||Meta|
|UCare to Suspend Authorizations in 2019 for UCare Choices Plans||2018-11-01||Bulletin||UCare suspend the PA requirement for prior authorizations UCare Choices and Fairview UCare Choices - UCare Individual & Family Plans and UCare Individual & Family Plans with Fairview IFP not need to submit prior authorization requests for medical services, behavioral health services and provider-administered drugs for these members from dates of service of Jan. 1, 2019, to Dec. 31, 2019. Notification requirements will remain in effect for inpatient services, skilled nursing facility admissions, nursing home facility admissions, and transplants.|
|New Drug Prior Authorization Removals Beginning July 1, 2018||2018-06-22||Bulletin||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|
|December 2018 health lines||2018-12-03||health lines||UCare's Salute to Excellence, 2019 Authorization & Notification Grids, Medicare Cost Plan changes in 2019, accurate member information, Model of Care Training, zero unit/minutes billing, Alliance of Community Health Plans and UCare, submitting unlisted codes, documentation for diagnosis capture, Holiday Hours, IFP Crosswalk for 2019 web tip|
|2019 Pharmacy Formulary Update||2018-12-05||Bulletin||UCare pharmacy formulary changes taking effect Jan. 1, 2019. 2019 Ucare Medicare plans and Individual & Family plans IFP. 2019 Opioid edits|
|August 2017 health lines||2017-08-16||health lines||Changes to payments outside US, child teen checkups, cervical cancer screening, antidepressant medication management provider toolkit, documentation for peripheral arterial disease|
|UCare Announces Changes Affecting Claims Editing for UCare Choices Plans Beginning Jan. 1, 2019||2018-11-29||Bulletin||Choices Individual & Family Plans IFP Editing Jan. 1, 2019 Expanded SNIP Edits SNIP 1-2 SNIP 1-5 Invalid Character or data element Date of service numeric format CCYYMMDD Custom Edits - Taxonomy Requirements and APRDRG Birth Weight required Ambulance pick up/drop off location required Diagnosis code Admission dates inpatient claims The taxonomy code on transaction date Custom Edits - 2018 CE plus Zero Units/Minutes will not be accepted Optum Claims Editing System™ (CES) Optum Prospective Payment System™ (PPS)|
|January 2019 health lines||2019-01-03||health lines||changes for PCA and HCN services billed to members under age 65, new product names IFP UCare Medicare Plans, 2019 Opioid Edits, enhanced prior authorization DME/Supply form, and documentation improvement for MI.|
|Provider Assurance Statement for Telemedicine Required to Deliver Telemedicine Services to Certain UCare Members||2017-02-23||Bulletin||Informs UCare providers of required Provider Assurance Statement for Telemedicine submission before supplying telemedicine services to members enrolled in Minnesota Health Care Programs (MHCP) and Commercial products.|
|Additional Enrollment Opportunities for Medicare Members||2019-01-07||Bulletin||Special Enrollment Period (SEP) - Dec. 8, 2018 to Feb. 28, 2019 Medicare Advantage Open Enrollment Period - Jan. 1, 2019 to March 31, 2019|
|Billing Reminders for Home Infusion Services||2019-01-15||Bulletin||MCHP billing guidelines for home infusion services|
|Updates on 2019 Claim Rejection Edits||2019-01-15||Bulletin||2019 Rejection Edits Zero Units Code Edit: Beginning Jan. 15, 2019, service lines that are billed with a UN qualifier must be billed with the appropriate units. If the units are missing or equal to zero (0), claims will reject back to the submitter on a 277ca. Zero Anesthesia Minutes Edit: Beginning Jan. 15, 2019, service lines that are billed with a MJ qualifier must be billed with the appropriate minutes. If the minutes are missing or equal to zero (0), claims will reject back to the submitter on a 277ca. Individual & Family Plans, IFP, new payer ID, new payor id, 55413 A3:33:40 unprocessable claim Subscriber and subscriber ID not found 52629 dates of service in 2018 A3:21:40 variations in rejections Workgroup for Electronic Data Interchange (WEDI) Strategic National Implementation Process (SNIP) Validation edits UCare Choices and Fairview UCare Choices|
|NPI Edit Error Impacting Atypical Providers with Availity||2019-01-15||Bulletin||Atypical Providers Only: NPI Edit Error Impacting Atypical Providers with Availity UCare has been alerted that there is an issue with Availity – atypical transportation providers are receiving “...MISSING BILLING PROVIDER NPI” rejection in error for billing without an NPI. Availity has informed us that they have classified this issue as a high priority. We will update this notice as we learn more. Please direct any questions about this issue to Availity. We apologize for the inconvenience.|
|Updates on Member Eligibility Services for 2019 Individual & Family Plan Members||2019-01-14||Bulletin||IFP, IVR, 270/271, HIPPA Transactions, eligibility|
|December 2017 health lines||2017-12-15||health lines||UCare 2018 benefit change summary, UCare member rights responsibilities, HIPAA verification, 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|
|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.|
|February 2017 health lines||2017-02-15||health lines||UCare Provider Manual updated, National Coverage Determinations - late update from CMS for ICD-10-CM diagnosis codes, Medicare Outpatient Observation Notice, Access the 270/271 transaction and save time verifying member eligibility and benefits, JW Modifier for Reporting Drug Waste, Consumer Assessment of Healthcare Providers & Systems (CAHPS) Survey, Health Outcomes Survey highlight: monitoring physical activity, Documentation improvement: chronic conditions, Mental health webinar: providing mental health services to Latinos|
|January 2017 health lines||2017-01-17||health lines||Update on taxonomy code requirements, Medicare-Assist at Surgery and use of -AS modifier, Health Outcomes Survey highlight: falls prevention, Documentation improvement: diabetes, Improving patient health through collaboration|
|July 2017 health lines||2017-07-14||health lines||Enhanced prior auth forms for EW, genetic testing and PCA providers, 2017 Medicare pricing software for MSHO and Connect + Medicare, CMS Ruling on continuous glucose monitors, Documentation Improvement: Arrhythmias,Cervical Cancer Screening webinar July 2017, MIPS estimator available to assist providers, high blood pressure and cholesterol education|
|Transportation Services Update||2017-04-14||Bulletin||Informs transportation providers about UCare's upcoming expansion of MinnesotaCare and Medical Assistance services in Minnesota, Transportation updates to the Provider Manual.|
|CES Facility Editor LCD Implementation||2017-12-19||Bulletin||Feb 1, 2018, UCare implemented Medicare Facility LCD/NCD policy edits for most Outpatient Facility claims through a third party software, improve editing accuracy and consistency by aligning more closely with Centers for Medicare and Medicaid Services’ (CMS) policies.|
|Unauthorized Provider Services||2017-12-20||Bulletin||New Standards for Unauthorized Provider Services; Identification of Non-Participating Provider Services Eligible for In-Network Benefits;Payment to Non-Participating Providers|
|Critical Business Reminders||2017-12-15||Bulletin||UCare informs providers of critical business reminders regarding UCare's Quality Program; Pharmacy; Clinical Practice Guidelines; Complex Case Management Referral Process; Utilization Management; Member Rights and Responsibilities Statement; Appeal and Grievance Procedure Reminder; and Disease Management Information.|
|Provider Manual Update||2017-02-14||Bulletin||2017 Provider Manual updates for Claims & Payment , Medical Necessity Criteria , Behavioral Health , Child & Teen Checkups , Home Care Services , Hospital Services , Interpreter Services, Obstetrics & Gynecology.|
|Expansion of SPP Services||2017-02-17||Bulletin||On May 1, 2017, UCare will begin serving an estimated 165,000 additional Prepaid Medical Assistance Program (PMAP) and MinnesotaCare members in Minnesota.|
|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; 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 has been added; Fraud, Waste and Abuse section; Well Child Care Coding for Quality Measurement and Payment; UCare’s Smoking and Tobacco Cessation Programs.|
|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|
|Tips & Reminders Regarding Nursing Facility Liability Letters||2018-12-06||Bulletin||100 Day Skilled Nursing Facility/Nursing Facility benefit period, 180 Day Skilled Nursing Facility/Nursing Facility benefit period, Liability Notification Letters, UCare’s Timely Filing Policy, Nursing Facility Communication Form (DHS 4461).\, Minnesota Senior Health Options, Minnesota Senior Care Plus and Special Needs BasicCare, prior authorization|
|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||Beginning April 16, 2018, UCare will temporarily add a second payment cycle each week to address the recent increase in claim volume we are experiencing. Remit payments will occur on Wednesdays and Fridays.|
|All UCare Providers: Critical Business Reminders (new template)||2018-07-25||Bulletin||NCQA accreditation requirements for Credentialing, Pharmacy, Complex Case Management, Utilization Management, Member Rights and Responsibilities, and Disease Management.|
|New Provider Search Tool for Members||2018-07-23||Bulletin||new search tool that will help members find providers in their network. home.ucare.org|
|Code and Editing Updates Reminder||2018-12-14||Bulletin||UCare automated claims editing and pricing applications- avoid submissions/adjustments/incorrect editing of the claims. UCare’s Provider Manual, Claims Chapter,|
|March 2017 health lines||2017-03-23||health lines||UCare to expand MnCare & Medical Assistance services in Minnesota; Taxonomy code requirements now in effect for claims payments; UCare replaces modifier for submitting separately payable laboratory tests for State Public Program members; New provider appeal process and form; Health Outcomes Survey highlight: Improving or maintaining mental health; Documentation improvement: Focus on "history of"; Practitioner's rights related to the credentialing process|
|May 2017 health lines||2017-05-15||health lines||Transition resources for providers, Providers encouraged to use self-service options, UCare's MSHO Model of Care trainings for providers; Health Outcomes Survey hightlight: Improving bladder control, Behavioral Health practitioners must be eligible for Medicare., Documentation improvement: Focus on COPD, Did you know: UCare's Medicare Advantage plans waive the SNF 3-Day Rule?|
|November 2017 health l ines||2017-11-15||health lines||Management of Heart Failure in Adults clinical practice guideline approved, credentialing for notification of terminations, Model of Care training for providers for UCare's MSHO, UCare Connect+Medicare, advance directive resources, documentation for major depression, flu shots recommendation|
|UCare Renames Three Products for 2019||2018-10-17||Bulletin||UCare For Seniors, renamed UCare Medicare Plans. UCare Choices, available through MNsure, will be renamed UCare Individual & Family Plans. IFP Fairview UCare Choices, available through MNsure, will be renamed UCare Individual & Family Plans with Fairview.|
|October 2017 health lines||2017-10-15||health lines||Mark Traynor UCare President and CEO, UCare prior authorization forms, RelayHealth customer service, non-residential medication-assisted treatment, real-time Part D vaccine claims, Model of Care training for UCare's MSHO, UCare Connect+Medicare, credentialing with UCare, October breast cancer screening, documentation for breast cancer|
|September 2017 health lines||2017-09-15||health lines||CMS Interim Rate Letters submissions, Model of Care training for UCare's MSHO, UCare Connect+Medicare, Child Teen Checkup update, UCare’s 270/271 HIPAA transaction update, Provider Assistance Center, HPV vaccinations and STD screenings, documentation for hypertension, member rewards incentives, free car seats criteria|
|Jan. 1, 2019, Changes for Personal Care Assistance & Home Care Nursing Providers Serving Members Under Age 65||2018-12-11||Bulletin||Personal Care Assistance (PCA) and Home Care Nursing (HCN) providers, Minnesota Health Care Program recipients under age 65|
|New State Public Program (SPP) Medical Drug Prior Authorization Request Form effective September 1, 2018||2018-08-03||Bulletin||fax number and Injectable Drug Prior Authorization Form for Medical Injectable PA Prior Authorization requests (drugs administered in the clinic setting) for our State Public Program members.|
|Reconsideration Process Form||2017-02-28||Bulletin||UCare will implement a formal provider appeal process April 1, 2017, a new, Universal Claims Reconsideration Request Form.|
|Ambulance PPS||2017-01-17||Bulletin||Upon implementation of this new pricing tool, ambulance providers may experience processing and/or pricing changes as UCare aligns more closely with Medicare payment methodologies for ambulance services.|
|PPS Implementation Follow Up||2017-04-26||Bulletin||Tips to help providers interpret Explanations of Payment and remits with UCare's new Medicare pricing software, updated implementation date for the MSHO and UCare Connect+Medicare products.|
|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|
|UCare Choices Claims Submission Changes for 2019||2018-10-24||Bulletin||New Payor Payer ID 55413, new Member ID and format, Individual & Family Plans. IFP UCare Choices and Fairview UCare Choices plans (UCare Individual & Family Plans)|
|Expansion SPP Transitions||2017-04-24||Bulletin||UCare serving an additional 165,000 members of Prepaid Medical Assistance Program (PMAP) and MinnesotaCare.|
|Taxonomy Update||2017-02-09||Bulletin||A reminder of the requirement to include taxonomy codes on all professional and facility claims, claims submitted after March 1, 2017, will be rejected when billing and rendering or attending taxonomy is not properly reported.|
|PCA Service Updates||2015-12-10||Bulletin|
|Fairview Specialty Pharmacy||2016-11-16||Bulletin||Effective January 1, 2017, Fairview Specialty Pharmacy will become the exclusive specialty pharmacy for UCare’s State Public Programs and Health Exchange members.|
|Behavioral Health Update||2017-05-01||Bulletin||Authorizations/notification and billing for behavioral health services for Pre-Paid Medical Assistance Program (PMAP) and MinnesotaCare members|
|Taxonomy Cross Over Claims||2017-05-30||Bulletin||Beginning June 15, 2017, UCare will reject claims that need to be coordinated with UCare coverage (e.g., COB, Medicare crossover claims) that do not report taxonomy.|
|Mark Traynor Named UCare President and CEO||2017-10-11||Bulletin||UCare's Board Chair, Macaran Baird, M.D., announced that the Board's Executive Search Committee selected Mark Traynor, current Interim President and CEO as the organization's permanent President and CEO.|
|Real Time Part D Vaccine Claims||2017-10-15||Bulletin||Summary process, electronic claims adjudication portal Transa, electronically submit vaccine claims for their UCare members, patient charged the same copay that they would receive at a retail pharmacy at the time of service, and the physician is reimbursed for their cost in a timely manner.|
|Holiday Hours||2016-11-23||Bulletin||Special PAC Hours|
|Update to UFS Supplemental Vision||2015-12-30||Bulletin|
|CD RES Treatment Room and Board Billing Update||2015-02-27||Bulletin|
|Modifier 59 and New Companion Situational Modifier||2015-02-09||Bulletin|
|UCare to Implement Home and Community-Based Services Billing Changes||2018-06-29||Bulletin||Minnesota Health Care Programs (MHCP), claims processing,Home and Community-Based Services (HCBS) claims, Elderly Waiver, Customized Living|
|Formulary Changes||2017-12-11||Bulletin||A summary of 2018 UCare's pharmacy formulary changes for UCare for Seniors, EssentiaCare, UCare Minnesota Senior Health Options (MSHO) and UCare Connect + Medicare, Minnesota Health Care Programs (MHCP) - UCare Connect, MinnesotaCare, PMAP, Minnesota Senior, Care Plus, and UCare Choices and Fairview UCare Choices.|
|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|
|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|
|Physician Pricer||2017-01-18||Bulletin||Upon implementation of this new pricing tool, provides processing and/or pricing changes on claims submitted, specific services may price more closely with Medicare reimbursement ethodology than they have in the past:|
|New UCare Claims Payment Schedule effective July 23, 2018, and forward||2018-07-12||Bulletin||After a successful pilot, we will restart the program to add a second payment cycle each week effective July 23, 2018, going forward indefinitely.|
|Taxonomy FAQs||2017-02-09||FAQs||Frequently Asked Questions about taxonomy codes on all professional and facility claims and to inform providers when taxonomy is not properly submitted to UCare.|
|For Coders and Billers: Billing for Part B Vaccines and Immunizations||2018-08-27||Bulletin||G0008, G0009 G0010, vaccine or immunization, Medicare Part B vaccines, modifiers, NCCI edits|
|2018 Authorization and Notification Grids Available||2017-11-15||Letter||UCare's 2018 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: Behavioral Health, Contact for Approval or Notification column; 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. Deep Brain Stimulation and Hysterectomy no longer needs Prior Authorization.|
|Medicare Formulary Changes||2016-11-01||Bulletin||A summary of 2018 UCare's pharmacy formulary changes for UCare for Seniors, EssentiaCare, UCare Minnesota Senior Health Options (MSHO) and UCare Connect + Medicare, Minnesota Health Care Programs (MHCP) - UCare Connect, MinnesotaCare, PMAP, Minnesota Senior, Care Plus, and UCare Choices and Fairview UCare Choices.|
|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.|
|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.|
|RFP Follow Up||2015-08-24||Letter|
|Transportation Provider Provider Manual Updates||2015-12-04||Bulletin|
|April 2015 health lines||2015-04-13||health lines|
|August 2015 health lines||2015-08-18||health lines|
|December 2015 health lines||2015-12-15||health lines|
|February 2015 health lines||2015-02-19||health lines|
|January 2015 health lines||2015-01-15||health lines|
|June 2015 health lines||2015-06-15||health lines|
|March 2015 health lines||2015-03-15||health lines|
|May 2015 health lines||2015-05-15||health lines|
|November 2015 health lines||2015-11-15||health lines|
|October 2015 health lines||2015-10-15||health lines|
|September 2015 health lines||2015-09-15||health lines|
|UCare - Fairview Intent to Combine Expertise||2016-04-05||Bulletin||This week, UCare and Fairview signed a letter of intent to combine our health care and insurance expertise.|
|Behavioral Health Change||2016-07-11||Bulletin||Effective October 31, 2016, UCare will no longer utilize Beacon Health Strategies LLC (“Beacon”) to perform utilization review of behavioral health prior authorization requests.|
|ICD-10 DSM5 Behavioral Health||2015-08-18||Bulletin|
|EW Services Monthly to Daily Rate||2016-06-15||Bulletin||The Minnesota Department of Human Services (DHS) Aging and Adult Services Division is changing the authorization and billing codes for some Elderly Waiver (EW) services in order to simplify authorization and billing procedures.|
|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.|
|Behavioral Health Authorization Fax Number||2016-10-02||Bulletin||UCare will no longer utilize Beacon Health Strategies LLC (“Beacon”) to perform utilization review of behavioral health prior authorization requests after October 14, 2016.|
|Behavioral Health Changes to Medicaid BH Authorization and Notification Grid for EIDBI Services||2015-10-05||Bulletin||UCare will no longer utilize Beacon Health Strategies LLC (“Beacon”) to perform utilization review of behavioral health prior authorization requests after October 14, 2016.|
|Behavioral Health Prior Auth Change||2016-10-14||Bulletin||UCare will no longer utilize Beacon Health Strategies LLC (“Beacon”) to perform utilization review of behavioral health prior authorization requests after October 14, 2016.|
|April 2017 health lines||2017-04-19||health lines||UCare prepares for MnCare and Medical Assistance expansion, Taxonomy code requirements now in effect for claims payments, UCare's medical and behavioral health utilization criteria - medical necessity hierarchy, UCare's Medication Therapy Management program, STI annual testing day, UCare to launch member outreach campaign promoting annual wellness exams, Documentation improvement: focus on quality documentation|
|Provider Manual Update Transportation Section||2015-01-16||Bulletin|
|FQHC-RHC Payment Carve-Out Process||2015-07-30||FAQs|
|Behavioral Health Form Changes||2015-06-12||Bulletin|
|UFS Vision FAQs||2015-07-28||FAQs|
|2015 Excellence Awards: Cultural Care Clinics, Disability Care Clinics||2015-03-19||Bulletin|
|Behavioral Health Update Special Edition||2015-03-30||Bulletin|
|Behavioral Health Services Update||2015-05-19||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|
|June 2017 health lines||2017-06-15||health lines||Coming Soon: Enhanced prior authorization forms for Elderly Waiver, genetic testing and personal care assistant providers; Taxonomy code required on crossover claims; Updated information on submitting Provider Assurance Statement for Telemedicine; Antidepressant Medication Management and Follow-up after Hospitalization improvement projects; Twin Cities Mobile Market; Depression in older adults webinar; Documentation improvement: Common diagnosis coding errors|
|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|
|Billing for Mental Health and Chemical Dependency Services||2018-06-01||Bulletin||chemical dependency services for eligible members|
|Important Drug Recall Information||2018-07-30||Bulletin||Valsartan, heart failure, high blood pressure|
|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|
|FAQs - Suspension of Authorizations For UCare Choices and Fairview UCare Choices Members Effective Jan. 1, 2019||2018-11-01||FAQs||Faq the suspension of authorization for UCare Choices and Fairview UCare Choices IFP members that will take effect on Jan. 1, 2019. retro-authorizations and claim reconsiderations for 2018. medical necessity criteria. benefit exception process.|
|2019 EDI Claims Delays for UCare Individual & Family Plans ONLY||2018-12-27||Bulletin||IFP claims delay, health rules|
|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|