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Prior authorization data for Individual & Family Plans

Some medical services and medicines require UCare to approve their use before they are covered by your plan. Called prior authorization or preauthorization, this process ensures that UCare and your doctor are working together to determine if these procedures or medicines would benefit you and provide you with the best possible care.

Effective April 1, 2022, and each April 1 afterwards, the Minnesota Legislature requires all health insurance companies operating in Minnesota to post the previous calendar year’s prior authorization data for all individual and family plans. This data includes:

  • The number of prior authorization requests that were approved
  • The number of prior authorization requests that were denied. Denied prior authorization requests are sorted by:
    • Medical, mental health & substance use disorder and pharmacy services
  • Whether the denial was appealed
  • Whether the denial was upheld or overturned on appeal
  • The number of prior authorization requests that were submitted electronically
  • The reasons for prior authorization denial, including:
    • The member did not meet prior authorization criteria
    • Incomplete information submitted by the provider to UCare
    • Change in treatment program
    • The member is no longer covered by the plan



At UCare, we are dedicated to de-mystifying health insurance and providing useful information related to your care. If you have any questions or want to learn more about UCare prior authorizations, call a UCare Customer Service representative.

2023 prior authorization data
 Initial Determinations
Authorizations Approved
  Approved
All Types of Service
 5113  

  Appealed
Authorizations Denied by Type of Service
 Denied Total Appealed
 Overturned Upheld
Medical 266  62  25  37
Mental Health & Substance Use Disorder
 11  1  0  1
Pharmacy
1924  273  185  88
 Total 2201  336  210  126
 Authorizations Denied by Denial Reason
 Denied  
Patient did not meet prior authorization criteria
 1977
Incomplete information submitted by the provider to the utilization review organization
 223
Change in treatment program 0
The patient is no longer covered by the plan 1
 Total 2201
Requests submitted electronically and not by fascimile or e-mail  All
All Types of Service  5270