Dental Authorization:
For questions about 2025 services, contact DentaQuest. For questions about 2024 services, contact Delta Dental of Minnesota.

Genetic Testing:
UCare partners with Carelon to perform utilization management review for genetic testing authorizations for members in all UCare products, except Medicare Supplement plans. Contact Carelon for prior authorization through their provider portal (registration with Carelon required) or call 1-833-821-1954 for more information.

Medical Injectable Drug Authorization:
Direct all authorization requests to UCare’s delegate: Care Continuum, a subsidiary of Express Scripts Online (ePA) at www.Evicore.com | Phone: 1-800-818-6747 (toll free) | Fax: 1-877-266-1871

Medical Necessity Criteria

UCare’s Utilization Management Program is based on evidence-based medical necessity guidelines. UCare makes the criteria available online as well as to providers upon request by phone, fax, or email. InterQual Criteria can be accessed through the One Healthcare ID link.

One Healthcare ID

Reconstructive and Cosmetic Health Services Policy

Restricted Recipient Program Forms

Restricted Recipient Program
Restricted Recipient Reference Guide

Minnesota Restricted Recipient Program - State Public Programs & Special Needs Plans
Specialty Referral Form
Authorization for PCP Partners in Clinic
Restricted Recipient Program Intake Form

Restricted Member Program - Individual & Family Plans
UCare Individual & Family Plans Medical Referral for UCare Restricted Member Enrollee
UCare Individual & Family Plans Prescribing Privileges for PCP Partners
UCare Individual & Family Plans Restricted Member Program Intake Form

Universal Referral Form

All Products
This form is intended to communicate patient referrals between medical and behavioral health providers.

Universal Referral Form

Medical Injectable Drug Prior Authorization Resources

See the Medical Injectable Drugs requiring prior authorization.

Review Medical Drug Policies.

Participating providers can submit prior authorization, authorization adjustment and pre-determination requests to Care Continuum one of the following ways:

Online (ePA) via the OnePA Portal at www.EviCore.com. Providers can submit requests, check on the status of submitted requests, and submit an authorization renewal on the OnePA Portal. The site also provides 24/7 access, potential for real-time approvals and email notifications once a decision is reached.
Fax an authorization request form to Care Continuum at 1-877-266-1871.
Call Care Continuum at 1-800-818-6747.

Non-participating and MultiPlan providers can submit prior authorization, authorization adjustment and pre-determination requests to UCare one of the following ways:

Fax an authorization request form to UCare Clinical Pharmacy Intake at 612-617-3948.
By mail to UCare, Attn: Pharmacy at P.O. Box 52, Minneapolis, MN 55440-0052.

Providers that receive a claim denial will continue to work through the provider claims appeal process using the Provider Claim Reconsideration Request Form.

News & Alerts

Provider News Library

See current news below or click link for our full Provider News Library.

Visit Provider News Library

Newsletter Sign Up

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Partnership with Nokomis Health for claim audits

UCare partners with Minnesota-based Nokomis Health to perform post-payment claim audits to ensure accuracy across claim submissions. Nokomis Health is dedicated to supporting health plans in identifying potential claims submission errors.

See the Oct. 20 Provider Bulletin for details.

Housing Stabilization Services (HSS) program ending Oct. 31, 2025

On Aug. 1, 2025, Minnesota Department of Human Services (DHS) announced they will be terminating the Housing Stabilization Services (HSS) Program due to large-scale fraud. This provider bulletin explains what providers may experience at UCare with the termination of the program

See the Oct. 20 Provider Bulletin for details.

Reminder: UCare requires authorization of recuperative care that exceeds 21 days; new authorization form available

Providers must request authorization when a UCare member requires recuperative care services greater than 21 days within the calendar year. This includes any readmission to recuperative care services for the same or a new diagnosis. Claims for days 22 or beyond that have not been authorized will result in denial. Additionally, UCare has a new authorization form that can be used for recuperative care authorizations.

See the Oct. 17 Provider Bulletin for details.

Pharmacy formulary and benefit changes for 2026

The 2026 UCare formularies and other pharmacy-related documents are now available on the Pharmacy page. The formularies are subject to change throughout the year and are updated on the first of each month.

See the Oct. 15 Provider Bulletin for details.

October 2025 Health Lines

Learn about the following: Frequently asked question, 2025 UCare Provider Manual Q4 update, Ineligible Provider List updated October 6, 2025, Quit Smoking and Vaping Program for maternity, Documentation improvement: major depressive disorder, Training for participating providers working with UCare, Fraud, waste and abuse reporting reminder, UCare provider news emails and upcoming holidays.

Read the October 2025 Health Lines.

Minnesota Department of Human Services (DHS) preferred drug list update

On Oct. 15, 2025, DHS will update the preferred drug list (PDL). These changes apply to UCare Medical Assistance (non-dual) plans. See bulletin for details.

See the Oct. 6 Provider Bulletin for details.

No change to vaccine coverage for UCare members

UCare understands the importance of vaccines and is making no changes to coverage for any vaccines. Vaccines, including the COVID-19 vaccines, will continue to be covered for all UCare plans.

UCare announces 2026 service area updates for UCare Connect + Medicare

UCare has made the difficult but necessary decision to adjust the service area of UCare Connect + Medicare (integrated, Special Needs BasicCare) beginning Jan. 1, 2026. This decision was part of a strategic roadmap established earlier in 2025 to ensure financial sustainability and mission continuity.

See the Oct. 1 Provider Bulletin for details.

Partnership with ClarisHealth for data mining and audits

UCare partners with ClarisHealth to perform post-payment claim audits to optimize payment accuracy across provider claim submissions. ClarisHealth specializes in data mining and claim review to identify and recover funds from incorrectly coded or billed claims, and claims that don’t adhere to published Centers for Medicare and Medicaid Services (CMS) and the Department of Human Services (DHS) standards and guidance.

See the Sept. 22 Provider Bulletin for details.

Updated prior authorization criteria for drugs on the Individual and Family Plans formulary

On Nov. 1, 2025, UCare will update prior authorization criteria for a drug on the UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview formulary.

See the Sept. 16 Provider Bulletin for details.

UCare to suspend certain Medicare Advantage products beginning in 2026

UCare has made the difficult decision to no longer offer any Medicare Advantage HMO, POS, PPO or Group Medicare products beginning Jan. 1, 2026. This also includes the EssentiaCare product. This step reflects rising medical and pharmacy costs that have made it increasingly difficult to sustain these products while protecting UCare’s overall stability and mission.

UCare is committed to keeping providers informed and supported during this transition. UCare is developing a frequently asked questions (FAQ) webpage with guidance to address questions. The FAQs will be updated as new information becomes available.

See the Sept. 5 Provider Bulletin for details.

Critical non-emergency medical transportation (NEMT) claim submission reminders

When submitting claims for NEMT, remember the tips related to each type of claim outlined in the following bulletin.

See the Sept. 2 Provider Bulletin for details.

Updated information about PCA and CFSS enhanced rates and tiered rates

UCare follows MN DHS guidance. See the revised Provider Bulletin for enhanced rate and tiered rate reminders, including how to bill, qualifying training and more.

See the Aug. 20 bulletin.

UCare to implement new pricing software for UCare IFP claim payments

Starting Oct. 1, 2025, UCare will use a third-party pricing software to calculate pricing on most professional services claims for UCare Individual and Family Plans claims

See the Aug. 15 Provider Bulletin for details.

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.

See July 10 Provider Bulletin for details.

2025 UCare enrollment changes for Medical Assistance

At the beginning of 2025, UCare and the Minnesota Department of Human Services (DHS) agreed to temporarily freeze UCare’s new enrollment in Prepaid Medical Assistance Program (PMAP) in all counties except Hennepin County to mitigate financial losses and constraints. The freeze was expected to result in gradual enrollment losses throughout 2025. However, members continue to enroll at higher rates than anticipated and medical expenses continue to increase significantly. As a result, UCare and DHS agreed to further freeze enrollment in PMAP, MinnesotaCare and Special Needs BasicCare (SNBC) UCare Connect, as well as reduce UCare’s service area for PMAP and MinnesotaCare beginning Sept. 1, 2025.

See the July 9 Provider Bulletin for details.

Authorization

UCare Authorization & Notification Requirements

Medical Services

Mental Health & Substance Use Disorder Services (MHSUD)

Pharmacy Services

Supplemental Information

Questions? Contact the Provider Assistance Center