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Welcome UCare Providers

EFT/ERA Instructions

Provider Payment & Remittance Selection

Instructions to Complete the Provider Payment and Remittance Request Form

  • Field names in bold are required.
  • Please allow a minimum of 10 business days for processing.
  • Email EFT835@ucare.org with questions about how to complete this form.
  • To cancel the form, click the Cancel button.
  • NOTE: the form cannot be saved and submitted later.

Complete the Provider Information Section

This section must be completed for all submission reasons.

  • Provider Name field - enter the legal name of the institution, corporate entity, practice or individual provider.
  • Provider Address Street field - enter the number and street name a facility can be found.
  • Provider Address City field - enter the city associated with the provider address.
  • State/Province field - enter the two-character code associated with the state/province/region of the applicable country associated with the provider address.
  • Zip Code/Postal Code field - enter the zip code/postal code associated with the provider address.

Complete the Provider Identifiers Section

This section must be completed for all submission reasons.

A Provider Federal Tax Identification Number (TIN), also known as an Employer Identification Number (EIN), is a nine-digit number used to identify a business entity. The Federal TIN must be entered exactly as it appears on your SS-4 (corporate) or Social Security card (individual).

A National Provider Identifier (NPI) is a unique ten-digit identification number for covered health care providers. Covered health care providers, all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPPA. The NPI must be used in lieu of legacy provider identifiers in the Health Insurance Portability and Accountability Act (HIPAA) standards transactions.

If the requester is a typical provider enrolled with the Minnesota Department of Human Services, the provider’s unique Minnesota provider identifier (UMPI) should populate the NPI field.

  • Provider Federal Tax Identification Number (TIN) field - enter a nine-digit number.
  • National Provider Identifier (NPI) field - if the provider has been enumerated with an NPI, enter the ten-digit number; add all the NPIs associated with the TIN to be included with this election.
    • NOTE: Only 20 NPIs can be entered on a single form. If you need to enter more NPIs, fill out an additional form.

Complete the Provider Contact Information Section

This section will auto-populate with your first and last name, email address and telephone number used in your provider portal access setup. Verify the information contained in those fields is correct.

Complete the Electronic Funds Information Section

Answer the EFT questions to determine which EFT form will display to assist in submission of the form.

Do you need to add or change your payment method or banking information?

  • Select “Yes” or “No.”
  • If “No,” no additional questions or fields will display.
  • If “Yes,” answer the next question.

Are you currently enrolled to receive electronic payments from UCare via EFT?

  • Select “Yes” or “No.”
  • If “Yes,” choose from the following:
    • “I need to change my payment method to check.”
    • “I need to change my banking information.”
  • When “I need to change by payment method to check” is selected, enter the address information where payment should be mailed into the Payment Address fields.
  • When “I need to change my banking information” is selected, enter the current financial banking information that is setup with UCare and then enter the new financial banking information.

Complete the Current Financial Institution Information Section

This information must be completed for all EFT change requests.

  • Current Financial Institution Name field - enter the official name of the provider’s financial institution.
  • Current Routing Number field - enter the nine-digit identifier of the financial institution where the provider maintains an account to which EFT payments are deposited.
  • Current Account Number field - enter the provider’s account number at the financial institution to which EFT payments are deposited.
  • Current Type of Account field - select the type of account (checking or savings) at the financial institution to which EFT payments are deposited.

Complete the New Financial Institution Information Section

This information must be completed for all payment selection submissions.

When the payment method is EFT:

  • Financial Institution Name field - enter the official name of the provider’s financial institution.
  • Type of Account field - select the type of account the provider will use to receive EFT payments, e.g., checking or savings.
  • Routing Number field - enter the nine-digit identifier of the financial institution where the provider maintains an account to which payments are to be deposited.
  • Account Number field - enter the provider’s account number at the financial institution to which EFT payments are to be deposited.

Are you currently enrolled to receive electronic payments from UCare via EFT?

  • Select “Yes” or “No.”
  • If “No,” answer the next question.

Would you like to enroll to receive electronic payments from UCare via EFT?

  • Select “Yes” or “No.”
  • If “No,” no additional questions or fields will display.
  • If “Yes,” enter the official name of the provider’s financial institution into the New Financial Institution Name field.
    • Type of Account field - select the type of account the provider will use to receive EFT payments, e.g., checking or savings.
    • Routing Number field - enter the nine-digit identifier of the financial institution where the provider maintains an account to which payments are to be deposited.
    • Account Number field - enter the provider’s account number at the financial institution to which EFT payments are to be deposited.

Complete the Electronic Remittance Advice Clearinghouse Information Section

Answer the ERA questions to determine which ERA form will display to assist in submission of the form.

Do you need to add or change your remittance method or information?

  • Select “Yes” or “No.”
  • If “No,” no additional questions or fields will display.
  • If “Yes,” answer the next question.

Are you currently enrolled to receive electronic remits (835) from UCare via a clearinghouse?

  • Select “Yes” or “No.”
  • If “No,” move to the next question.
  • If “Yes,” choose from the following:
    • "I need to change my clearinghouse.”
    • “I need to change my remit method.”

When “I need to change my clearinghouse” is selected, complete the Current Electronic Remittance Advice Clearinghouse Information section. This section must be completed for ERA change requests.

  • Current Clearinghouse Name field - select the official name of the provider’s clearinghouse.
  • New Clearinghouse Name field - select the official name of the provider’s clearinghouse.

When “I need to change my remit method” is selected, the Electronic Remittance Advice Clearinghouse Information section must be completed for all remittance selection submissions.

  • Method of Retrieval field - select the method in which the provider will receive the ERA from the health plan.
    • When the method of retrieval is “UCare Provider Portal,” ERA form will be retrieved from the portal (for paid claims only).
  • Remittance Address field - when the payment method is paper, enter the address information where remittance should be mailed (option not available to Minnesota providers).

Would you like to receive electronic remits (835)?

  • Select “Yes” or “No.”
    • If “Yes,” select the official name of the provider’s clearinghouse from the New Clearinghouse Name field.
    • If “No,” and the provider is in the state of Minnesota, the “I am electing to receive remits via UCare Provider portal” box must be checked.
    • Providers in other states may elect to receive the ERA form via paper or the UCare Provider Portal.
      • If “paper” is selected, enter the address information where remittance should be mailed into the Remittance Address field.
      • If “UCare Provider Portal” is selected, ERA form will be retrieved on the portal (paid claims only).

Complete the Authorized Signature Section

This section must be completed for all submission reasons.

  • Electronic Signature of Person Submitting Request field - enter the name of the person signing the form.
  • Printed Title of Person Submitting Request field - enter the printed title of the person signing the form.
  • Submit button - click to submit the form; the system will verify that all required fields are complete.