Check member eligibility
See a member’s copays and benefits
Check claim status
View Remittance Advice
Check out the news archive of Health Lines provider newsletter and Provider Bulletins.
Policies & Resources
UCare Provider Manual
Benefit and product information
Claims & billing information
And much more
Mental and Substance Use Disorder Services
Join Our Network
Find Credentialing information
Search for providers
Manage your information
News & Alerts
Provider News Library
Newsletter Sign Up
Discussing a Pre-Service Denial With a Reviewer
Beginning May 1, 2023, practitioners will have 14 calendar days from the denial notice date of an authorization to initiate a discussion of a pre-service authorization denial decision.
March 2023 Health Lines
Learn about the following: UCare Achieves NCQA Health Equity Accreditation for Medicaid Products, Provider Portal Access, When to Prescribe a Biosimilar, Keeping UCare Members Active and Healthy, Fraud, Waste and Abuse Reporting Reminder.
2023 Editing Update for Laboratory Services
Beginning April 1, 2023, for all products, UCare will deny referred laboratory claims with dates of service Jan. 1, 2019, or later when a claim is received by both a reference laboratory and a referring laboratory for the same member, date of service and procedure code.
Updated Prior Authorization Criteria for Drugs on the IFP Formulary
Starting April 1, 2023, UCare is updating prior authorization criteria for three drugs that are on the UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview formulary.
UCare Provider Manual Updated for 2023UCare’s 2023 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 Provider Manual.
Screening, Brief Intervention and Referral to Treatment (SBIRT) Update
Effective Jan. 1, 2023, UCare members enrolled in Prepaid Medical Assistance Program, MinnesotaCare, UCare’s Minnesota Senior Health Options, Minnesota Senior Care Plus, UCare Connect and UCare Connect + Medicare are eligible to access substance use disorder (SUD) services after completing a SUD screening through the SBIRT process.
UCare Announces Updates to Transplant Services Notification Form and Process
UCare has updated the Transplant Services Notification Form and process. The updates align with the 2023 Authorization Grids for all product lines. UCare requires notification at three junctures in a member’s transplant journey.
2023 Code and Editing Updates
New codes have been identified for 2023 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.
Please see the December 8 Provider Bulletin for additional details.
CMS Crossover Durable Medical Equipment (DME) Claims Not Sent to UCare for Payment
In early 2022, UCare had a connectivity issue with the Centers for Medicare & Medicaid Services (CMS) related to crossover claims. UCare and CMS remedied this issue beginning April 17, 2022. In July 2022, CMS and UCare coordinated a recovery process to resend crossover claims missing from the early part of 2022. Based on recent claims inquiries from DME providers, UCare and CMS found a gap in the recovery process. UCare has confirmed these claims were not included by CMS in the recovery process. UCare has also confirmed that DME claims cannot be included in a similar recovery process.
Please see the December 7 Provider Bulletin for more information.
340B Drug Payment Changes
UCare follows the Centers for Medicare and Medicaid Services (CMS) billing requirements and reimbursement guidelines for certain drugs purchased under the 340B Drug Pricing Program. CMS recently published information regarding payment changes for these drugs in accordance with the ruling from the United States District Court for the District of Columbia. UCare has implemented these payment changes.
Addressing Disability & Creating Access Training: Understand and Remove Barriers
Providers and their staff are invited to learn how to address disability and create access in their work at a free, online CEU program sponsored by UCare. Linda Wolford, MS, and Kaitlin Desselle, MS, from Strategic Diversity Initiatives (SDI), and Mai Thor, co-facilitator and disability justice advocate, will present a disability provider training from 12 - 1 pm, Wednesday, Dec. 7, 2022, via Zoom.
Please see the Class Offerings webpage for additional details and to register.
Pharmacy Formulary and Benefit Changes for 2023
Information about the 2023 formularies and changes to benefits is now available.
Medical Benefit Drug Prior Authorization for 2023
Medical Benefit Drug Prior Authorization for 2023 and Preferred Product Step Therapy Information now available.
UCare's 2023 Authorization & Notification Grids
The UCare 2023 authorization and notification requirements are now available.
For a list of changes, please see the November 9 Provider Bulletin.
View the 2023 authorization grids in the Resources and Information section of the Authorizations page.
UCare Transitions to New Provider Portal
UCare has launched its new Provider Portal. In the coming weeks, Portal Administrators and Users will be notified to set up their accounts in the new portal.
Please see the November 7 Provider Bulletin for additional details about the new portal and what to expect during the transition.
Personal Care Assistance (PCA) Service Reminders
UCare would like to remind PCA provider agencies of requirements to help ensure providers are documenting visits correctly and that claims are paid appropriately.
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.
Information on UCare’s New Claims SystemSee all related Provider Bulletins outlining the changes you can expect with UCare’s new claims system. Visit the New Claims System page.
Give Us a Call
Provider Assistance Center:
612-676-3300 or 1-888-531-1493
Hours: 8 am – 5 pm, Monday – Friday
Report Fraud, Waste and Abuse:
Register for a Provider Portal Account
Access Your Provider Portal Account to access member eligibility
and claim status information.
Current Provider Portal Quick Reference Guide (PDF)
New Provider Portal Quick Reference Guide (PDF)
Need help registering?
Contact your provider administrator to create
and modify user accounts
Send Us a Fax or Email
Claims Attachments: 612-884-2261
Claims Adjustments: 612-884-2186
Prior Authorization Requests:
612-884-2499 or 1-866-610-7215
Rate Updates (CAH, RHC, FQHC): RateLetters@UCare.org