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Provider News Library
September 2023 Health Lines
Learn about the following: Flu Shot Season, UCare's Unclaimed Property Notices, September is Falls Prevention Awareness Month, Juniper® Health Management and Wellness Classes, Documentation Improvement: Sepsis, Medicare Supplement Reminders, Accurate Member Information is Key to Smooth Claim Submissions and Fraud, Waste and Abuse Reporting Reminder.
Early Intensive Development and Behavioral Intervention (EIDBI) Claims Payment Reminder
UCare follows Minnesota Department of Human Services (DHS) guidelines, found in the MHCP Provider Manual, for the rendering and billing of EIDBI services.
In accordance with DHS guidelines, the practitioner who provides the service must bill the service as the rendering provider. Only list a Qualified Supervising Professional (QSP) as the rendering provider if they personally performed the service. Otherwise, list the QSP as the person who is supervising the rendering provider in addition to the rendering provider.
UCare Provider Manual Updated for Q3 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.
Reminder: Complete the Disclosure of Ownership, Control and Management Information and Exclusions Statement for Providers Form
In June, UCare asked providers to complete and submit the Disclosure of Ownership (DOO), Control and Management Information and Exclusions Statement for Providers form. Providers who still need to submit their completed form should do so as soon as possible.
Medical Assistance and MinnesotaCare Disenrollments Begin Aug. 1
The Minnesota Department of Human Services (DHS) began the Medical Assistance and MinnesotaCare renewal process, and some UCare members are at risk to lose their coverage as early as Aug. 1. Members who didn’t renew their coverage, and believe they are still eligible, can still renew their coverage and may be eligible for retroactive coverage.
Updated Prior Authorization Criteria for Drugs on the IFP Formulary
Starting September 1, 2023, UCare is updating prior authorization criteria for two drugs that are on the UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview formulary.
Expedited Appeal Requests Reminder
UCare’s Appeals and Grievances Department has seen an uptick in appeals for FDA-approved weight-loss medications including Wegovy and Saxenda. Several of these requests are filed as expedited. Providers are encouraged to review the criteria for expedited appeal requests.
Children’s Residential Treatment Authorization and Notification Requirements Temporarily Changed for Individual and Family Plan Members
Effective June 12, 2023, to Dec. 31, 2023, UCare is temporarily waiving prior authorization requirements for UCare Individual and Family Plans and UCare Individual and Family Plans with M Health Fairview for children’s residential treatment facilities before admission.
Critical Business Reminders
UCare provides Critical Business Reminders annually to update our provider network on important business information. View our updated Critical Business Reminders webpage here. You'll find updates to the credentialing and recredentialing process, pharmacy section, Complex Case Management Program referral process, utilization management (UM), affirmative statement, how to request UM criteria and obtain access to UM staff, Member Rights and Responsibilities, links to shared decision-making (SDM) resources and links to training and resources on culturally congruent care.
Inpatient Hospital Readmission Payment Policy UpdatedUCare recently updated the Inpatient Hospital Readmission Payment Policy. As part of this policy update, UCare's third-party vendor, Optum, will conduct post-payment reviews of applicable inpatient hospital admissions to assess whether the multiple hospital stays should bundle into one hospital confinement. Audits will start with claims paid July 15, 2023, and later.
See the June 1 Provider Bulletin for details.
End to COVID-19 Public Health Emergency
The COVID-19 Public Health Emergency (PHE) ended on May 11, 2023. UCare has revised its COVID-19 guidance for providers. Review UCare COVID-19 Information for Providers page for more information regarding these changes.
Provider Enrollment With Minnesota Health Care ProgramsUCare providers who are contracted to provide services to Medicaid members will be expected to enroll with Minnesota Health Care Programs (MHCP) starting July 17, 2023. Resources are available to help prepare for the enrollment process. See the May 17 Provider Bulletin.
Temporarily Changes to Post-Acute Care Authorization and Notification Requirements
Effective May 12, 2023, to Dec. 31, 2023, UCare is waiving prior authorization requirements for all plans before admission for Long-Term Acute Care Hospital (LTACH) and Acute Inpatient Rehabilitation (AIR).
Redeterminations and Renewals
The Minnesota Department of Human Services (DHS) has reinstated Medicaid redeterminations (or renewals) for Medical Assistance members. The renewal process started with Medical Assistance members who have a renewal date of July 1, 2023. This is the first date members could lose coverage for failing to renew their eligibility with the state and county.
2023 Summer Camps Available for Young UCare Members
This summer, UCare will team up with Minnesota camps to offer opportunities for young UCare members in Prepaid Medical Assistance Program (PMAP) and MinnesotaCare plans.
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.
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