UCare - Providers - Past Announcements

Changes to EW Claims Processing and Adjustments Effective 12/1/11 Please note that this will only affect EW providers in Greater MN.

Effective 12/1/11, all EW service claims (newly submitted and adjustment request claims) for UCare's MSHO and MSC+ members, regardless of DOS, will be submitted to UCare for adjudication rather than the state's system, MMIS. DHS will no longer process EW service claims and adjustment requests for UCare members after 11/30/11.

A letter was sent out on 11/3/11 to all of the EW providers in Greater MN who will be affected by this change. For a copy of the letter, please click here.

Special Newsletter for Skilled Nursing Facilities/Nursing Homes 

A newsletter has been especially created for the skilled nursing facilites/nursing homes. This newsletter brings you information regarding:

• Waiver of the 3-day Inpatient Hospital Stay.
• Sending Proper Notifications to the Approval Authority.
• Two Most Common Billing Denials.
• Resources.

Click here to get your copy of this special newsletter or "health lines BULLETIN" in the navigational pane for this, and previously posted news BULLETINS.

Delay in Claims Payable 

We have recently identified an error in our claims payment system; thus, causing a temporary delay in claims payable. We have resolved the issue and the claims that have been identified will be released next week. Please remember to use the UCare Provider Portal to view status of your claims.

EDI Mapping Issue Identified:  Rejection Code 066

Recently, UCare has identified a mapping issue that affects inpatient institutional claims (837I) when coordination of benefits (COB) fields is populated. UCare is in the process of making the necessary changes to correct this edit/mapping error. When the error has been corrected, we will post another message.

Formulary Changes for Lipitor and Vytorin Drugs

Posted 10/1/10

Posted 11/3/10

Pharmacy Updates on J-Code Denials

Posted 10/25/10

Notice from UCare re:  State Emergency Declaration

Attention Personal Care Assistance (PCA) Providers:

Posted 10/1/10

Introducing the New UCare Provider Portal

Posted 9/14/10

Attention Durable Medical Equipment (DME) Providers

Claims Processing Changes for Part D Drugs Effective 8/1/10

Effective 8/1/10, UCare no longer reimburses for Part D drugs and the administration of Part D drugs for claims submitted to us by a health care provider. UCare follows the CMS guidelines and criteria for drugs that are usually self-administered.  We encourage our members to receive their Part D drugs and administration at the pharmacy.  This guarantees that members are charged for their Part D co-pay only and result in a lower out-of-pocket cost.

For additional information, please download a copy of our health lines BULLETIN (2010 Pharmacy Updates, including Part D Drugs) by clicking on the link.

Published 8/16/10

Electronic Claim Submission Requirement Effective July 1, 2010

Effective July 1, 2010, UCare will no longer accept the submission of professional and institutional paper claims, according to the Minnesota State Statute 62J.536.

Click here to read more about the requirements and actions you need to take in order to avoid return of paper claims and processing delays. This health lines BULLETIN is particularly important to providers who currently submit paper claims.

Published 5/19/10

UCare Restricted Recipient Program Announcement

Click here to read more about the importance of this program.

Published 6/30/10

Attention ClearConnect Users!

Effective immediately, if you have not switched to another clearinghouse to receive your 835 files, you will be receiving paper remittance advices from UCare until you notify us by completing a Provider Payment Election Form.  Please note that you will also be out of compliance by not receiving your remittance advices electronically, according to the Minnesota State Statute, section 62J.536.

As a reminder, on 6/30/10, ClearConnect ceased all business operations. ClearConnect was one of the clearinghouses sending 837 files to UCare and receiving 835 files from us. Availity has purchased the business from ClearConnect, but Availity did not purchase the individual provider/client contracts. The transition for providers from ClearConnect to Availity is not automatic and providers will need to re-enroll for both the 837 and 835 transactions with Availity or another clearinghouse.

If you were using any of these services from ClearConnect and have not switched to Availity or to another clearinghouse that works with UCare, you will need to take immediate action to avoid interruptions to your accounts receivables. Please refer to UCare's Provider Manual, Chapter 6:  Claims Submission Information, for a complete list of clearinghouses that works with UCare. 

If you have registered with Availity, please note that the 835 enrollment process is separate from the registration process. You will need to complete Availity's Multi-Payer Enrollment form and fax it to them at 972-383-6450. If you have questions for Availity, they can be reached by calling their Client Services at 1-800-282-4548.

Originally published on 6/23/10. Revised as of 7/6/10.

New Medicare Covered Benefit:  Screening for the Human Immunodeficiency Virus (HIV) Infection

Effective for claims with dates of service on and after Dec. 8, 2009, the Centers for Medicare and Medicaid Services (CMS) will cover both standard and Food, Drug, and Administration (FDA)-approved HIV rapid screening tests for:

1. A maximum of one annual voluntary HIV screening of Medicare beneficiaries at increased risk for HIV infection per USPSTF guidelines and in accordance with Pub. 100-03, National Coverage Determinations (NCD) Manual, sections 190.14 and 210.7, and Pub. 100-04, Medicare Claims Processing Manual, chapter 18, section 130.
2. A maximum of three, voluntary HIV screenings of pregnant Medicare beneficiaries at the following times:  (1) when the diagnosis of pregnancy is known, (2) during the third trimester, and (3) at labor, if ordered by the woman’s physician, and in accordance with Pub. 100-03 and Pub. 100-04, as noted above.

This benefit will be covered by UCare for our following products:  UCare for Seniors, UCare Connect, and UCare's Minnesota Senior Health Options (MSHO). Although the implementation dates is not until July 6, 2010, the is covered effective Dec. 8, 2009.

For more information, refer to the NCD (Transmittal 118) by logging onto http://www.cms.gov/transmittals/downloads/R118NCD.pdf and/or Medicare Learning Network (MLN) Matters Article Number: MM6786 by logging on to http://www.cms.gov/MLNMattersArticles/downloads/MM6786.pdf.

Published 6/23/10

Removal of 16 Hours/Day Limitation for Personal Care Assistance (PCA) Services

To align with Minnesota Department of Human Services and statutory authority, UCare will no longer restrict PCA services to 16 hours per day. Effective May 1, 2010, UCare will remove the limitation on PCA services. UCare will continue to deny claims that exceed 24 hours per day per individual PCA.

Published 5/13/10

General Assistance Medical Care (GAMC) Change Effective 4/1/10

GAMC members that are currently enrolled in a prepaid managed care organization, such as UCare, will move to DHS fee-for-service effective 4/1/10. We encourage you to check MN-ITS to verify a member's eligibility on/after April 1st for program eligibility.

DHS recently published a provider update regarding provider impacts due to GAMC changes, Provider Update MHP-10-02. Click here to get a copy of the DHS Provider Update MHP-10-02. 

For the most current and up-to-date information regarding the GAMC plan, please visit the DHS web site at www.dhs.state.mn.us/gamc.

Published 3/31/10

2010 Healthcare Effectiveness Data and Information Set (HEDIS)

Each year in March, UCare begins the HEDIS medical record abstraction process, which includes Minnesota Community Measurement data collection, medical records standard review, and advanced directive review. UCare is contracting with MedAssurant to perform medical record data abstraction on our behalf. The HEDIS process will continue through May 2010.

Click here to view a copy of the 2010 HEDIS letter that was sent to UCare-contracted clinics in March 2010.

Published 3/15/10

Personal Care Assistance (PCA) Changes Effective 1/1/10

Effective January 1, 2010, all UCare members receiving PCA services will be reassessed using the new PCA Assessment and Service Plan, according to the 2009 Minnesota Legislative changes to the PCA program. Non-waiver members will be reassessed using the Department of Human Services (DHS) six-month reassessment schedule. Waiver members will be reassessed at their annual reassessment date.

UCare follows DHS criteria’s and legislative changes for the PCA program. For more information and additional resources, please refer to the following:

• UCare’s web site:  Provider Manual - Chapter 8:  Home Care Services.
• DHS web site:  PCA Portal, PCA 6-Month Reassessment Project, and/or Provider Update PCA-09-04. Visit DHS' web site at http://www.dhs.state.mn.us/ for the PCA updates.
• Minnesota Statute, section 256B.0625, subdivision 19a and Minnesota Statute, section 256B.0659, subdivisions 3a, 4, and 30.

Published 3/4/10

2010 Prior Authorization/Notification Grids 

UCare's prior authorization/notification grids for 2010 is now availale and posted (below) for your convenience.

› A few words from UCare's Chief Medical Officer
**Alert: Please review the authorization grids for GAMC and All other UCare products. UCare has added clarification regarding prior authorization requirements for Spinal Fusion, External and Implantable Bone Growth Stimulators, and Home Care (including skilled nursing visits and therapies).  In addition, refer to Chapter 5 of the Provider Manual.**

› Prior Authorization/Notification Grid for the General Assistance plan

› Prior Authorization/Notification Grid for all other UCare plans

› Pre-Notification/Authorization Grid for mental health/chemical dependency services

Published 12/4/09

Provider Alert:  Applying Co-pays for Vision Services in Error

UCare has identified an error in applying specialist office visit co-pays for vision services for our UCare for Seniors members. This affected claims that were finalized with dates of services in 2009 from vision providers. 

We have identified all the vision service claims that were assessed a co-pay in error and have reprocessed all of them as of today, 10/26/09. Vision providers will receive future explanation of payments (EOPs) showing the adjustment and payment of the co-pays.

If you are a vision provider and have collected co-pay(s) from a UCare for Seniors member, we apologize for the inconvenience and you should reimburse the patient(s) back their money.

Please call our Provider Assistance Center at the phone number(s) listed above.

(Posted 10/26/09)

Home Assessments

(Posted 8/27/09)

Provider Alert:  Potential Claim Payment Error 

UCare recently identified an error in adjudication for claims processed between the dates 7/10/09 - 7/16/09. This has created an environment in which incorrect providers may have been paid.  UCare has corrected the error and we apologize for the inconvenience this may cause. 

Claims that were affected by the payment error have been identified and currently being adjusted.

(Updated 8/27/09)