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Updates and Reminders to Avoid Claim and Claim Line DenialsIn preparation for the final stage of our new claims system implementation, UCare analyzed claim submission patterns against published billing standards and guidance, as well as UCare-specific requirements published in the Provider Manual. The new claims system automates a greater portion of billing-related edits than UCare’s legacy system. As a result, providers may see much more consistency in their claim and claim line denials beginning in 2022.
See the January 18 Provider Bulletin for more details.
Updated Prior Authorization Criteria for Drugs on the IFP Formulary
Starting March 1, 2022, UCare is updating prior authorization criteria for 22 drugs that are on the UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview formulary.
January 2022 Health Lines
Learn about the New Claims System Implementation, No Surprises Act Began Jan. 1, 2022, New Coverage Policies and Annual Review Added, Medical Necessity Guidelines, Flu Vaccine Reminder, New Health Promotion Programs for 2022, Documentation Improvement: Annual Evaluation, Ineligible Provider List Updated Jan. 4, 2022, Accurate Member Information is Key to Smooth Claim Submissions, Upcoming Holidays and more.
UCare Claims Rejection Analysis, Reminders and Requests
UCare began transitioning to a new claims system in January 2019. Throughout the implementation cycle of each product into the new claims system, UCare analyzed common reasons for claims rejections, claims denials and claims appeals. As UCare begins processing claims for the largest segment of our business – Prepaid Medical Assistance Plans, MinnesotaCare, UCare Connect, Minnesota Senior Care Plus, UCare’s Minnesota Senior Health Options and UCare Connect + Medicare, there is a greater likelihood provider groups will see an increase in claims rejections.
See the January 6 Provider Bulletin for a summary of common errors and tips for how to avoid them.
Medicare Eyewear Allowance Changes for 2022
Effective Jan. 1, 2022, members in UCare Medicare Plans, UCare Advocate Choice and UCare Advocate Plus, UCare Medicare w/M Health Fairview & North Memorial and EssentiaCare have a new way to pay for eyewear using their annual eyewear allowance benefit. The 2022 eyewear allowance has been loaded to the members' Reward Benefit Mastercard, which works like a debit card.
See the Jan. 4, 2022 Provider Bulletin for more information.
Updated 2022 Medical Services Authorization and Notification GridsUCare has reviewed the 2022 CPT and HCPC code changes as they pertain to our authorization grids for all UCare products. See the Dec. 27, 2021, Provider Bulletin for details.
Specialty Provider Referrals for Restricted Recipients
Beginning Jan. 1, 2022, UCare’s Restricted Recipient Program (RRP) will only accept specialty provider referrals that were submitted within 90 days of the service being rendered.
See the Dec. 20, 2021 Provider Bulletin for more information.
UCare Welcomes Former Blue Plus Members From Ramsey and Scott CountiesOn Jan. 1, 2022, UCare will welcome former Blue Plus members from Ramsey and Scott counties to its Prepaid Medical Assistance Plan (PMAP) and MinnesotaCare plans. Blue Plus will no longer be an option for these plans in Ramsey and Scott counties in 2022, and former Blue Plus members may elect or be defaulted to UCare’s plan.
See the Dec. 17, 2021 Provider Bulletin for more information.
Important Reminders About UCare’s Taxonomy Requirements
UCare relies on provider-submitted taxonomy for accurate and timely claims processing. As UCare moves to our new claims system, it is important to remind providers of several of the key taxonomy requirements to support claims processing.
See the Dec. 16, 2021 Provider Bulletin for more information.
No Surprises Act
Federal legislation titled the No Surprises Act (NSA) takes effect beginning Jan. 1, 2022.
See the Dec. 15, 2021 Provider Bulletin for more information.
2022 Code and Editing UpdatesNew codes have been identified for 2022 and will be accepted into the UCare system. New codes will have published effective dates but are subject to the editing update and implementation dates.
See the Dec. 10 Provider Bulletin for more information.
UCare to Offer Supplemental Eyewear Coverage Through Eye-Kraft for UCare’s Minnesota Senior Health Options (MSHO) and UCare Connect + Medicare Members
Beginning Jan. 1, 2022, UCare will offer supplemental eyewear coverage for MSHO and UCare Connect + Medicare members exclusively through Eye-Kraft.
See the Dec. 9, 2021 Provider Bulletin for more information.
UCare's 2022 Authorization & Notification Grids
The UCare 2022 authorization and notification requirements are now available.
View the 2022 auth grids in the Resources and Information section of the Authorizations page.
Pharmacy Formulary and Benefit Changes for 2022
Information about the 2022 formularies and changes to benefits is now available.
Medical Benefit Drug Prior Authorization for 2022
2022 Medical Benefit Drug Prior Authorization (PA) information is available.
Changes to 2022 Part D Vaccine Billing for UCare’s MSHO and UCare Connect + Medicare
Vaccine and administration will need to be billed through the member’s Part D benefit.
Changes Affecting Claims Submissions for UCare Medicaid and Integrated Duals Plans Beginning Jan. 1, 2022UCare is continuing to implement its new claims system. Effective Jan. 1, 2022, Prepaid Medical Assistance Program, MinnesotaCare, UCare Connect, UCare Connect + Medicare, Minnesota Senior Care Plus and UCare’s Minnesota Senior Health Options will have a new Payer ID and Member ID and format.
See the Oct. 28, 2021 Provider Bulletin for more information.
Critical Business Reminders
UCare informs providers of critical business reminders for the Credentialing and Recredentialing Process, Pharmacy, Complex Case Management Process, Utilization Management Information, Member Rights and Responsibilities, Practitioner Support Shared Decision-Making Aids and Clinical Practice Guidelines.
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