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Authorization

UCare Authorization & Notification Requirements

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Medical Services

Authorization and notification forms and product-specific information.

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Mental Health & Substance Use Disorder Services (MHSUD)

Authorization and notification forms and product-specific information.

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Pharmacy Services

Authorization and notification forms, formulary and recall information.

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Supplemental Information

The Behavioral Health Case Management Referral Form is completed when you have a UCare PMAP, MNCare, MSHO or MSC+ member who has a complex Behavioral Health condition.

Mental Health & Substance Use Disorder Case Management Referral Form (New 5.26.20)

The Care Management Referral form is completed when you have a member/patient who you feel would benefit from care coordination services and is actively enrolled in UCare Connect, UCare Connect + Medicare, PMAP (under 65), UCare Medicare Plans or Individual & Family Plans.

Care Management Referral Form - PDF
Care Management Referral Form - Word

The Complex Case Management Referral form is completed when you have a medically complex member/patient who you feel would benefit from short term / intensive medical case management. They typically have a new critical medical event, multiple medical diagnoses with challenges or high medical costs/utilization. This program is for UCare Medicare and Individual & Family Plans and PMAP/MNCare.

Complex Case Management Referral Form - PDF
Complex Case Management Referral Form - Word

UCare works with delegated organizations to handle the following types of authorization.

Chiropractic Authorization:
Direct all authorization questions to UCare's delegate, Fulcrum Health, Inc. | 1-877-886-4941 (toll free)

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

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

In order for services to be eligible for payment by UCare, the services must meet UCare’s standards for coverage, including medical necessity criteria. Coverage and benefits vary significantly among different UCare plans. Medical Necessity Criteria has been added to the Medical Authorization and Notification grids.

One Healthcare ID

Medical Necessity Criteria Request Form

Reconstructive and Cosmetic Health Services Policy

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

Universal Referral Form

 

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.

Questions? Contact the Provider Assistance Center 

Phone (local): 612-676-3300
Phone (toll free): 1-888-531-1493 
Hours: 8 am - 5 pm, Monday through Friday

News & Alerts

Provider News Library

See current news below or click link for our full Provider News Library.
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Revised Claim Payment Schedule

Revised Claim Payment Schedule: Due to our annual State DHS payment delays and withholds in the months of May and June, we are making slight changes to our provider remit payment schedule. For this week, remit payment will be made Thursday, May 1 and Friday, May 2 and the June 25 and 27 remit payments will be made Thursday, July 3.

See the updated payment calendar for the latest information.

UCare to implement Two-Midnight Rule review process on inpatient hospital claim submissions

Effective immediately, UCare will review claims submitted as an inpatient hospital stay that are less than two midnights and do not appear to meet the standards as listed in the Centers for Medicare and Medicaid Services' Two-Midnight Rule. Inpatient hospital claims that fail to meet the standards will be denied for UCare's Medicare Advantage, UCare's Minnesota Senior Health Options and UCare Connect + Medicare plans.

See the April 21 Provider Bulletin for details. 


UCare to Transition to Encounter Alert System

On June 1, 2025, UCare will move to the Department of Human Services Minnesota Encounter Alert System (EAS) vendor PointClickCare. The transition to the EAS provides the ability to send and receive real-time member encounter notifications.

See the April 17 Provider Bulletin for details. 

UCare selects Availity as new provider portal partner

UCare is partnering with Availity to develop its new provider portal, which will be available through Availity Essentials once completed. Availity Essentials is a multi-payer portal that offers providers a consistent experience for verifying member eligibility and benefits, submitting claims, checking claim status and more.

See the April 16 Provider Bulletin for details. 

April 2025 Health Lines

Learn about the following: UCare’s provider training, Ineligible Provider List updated March 25, 2025, UCare introduces new provider search, New coverage policies added, 2025 HPV vaccination promising practices series, Minnesota DHS PDL update, Planned home birth services now available for UCare members, Stress Awareness Month, Cecelia Health Diabetes virtual support program, UCare’s Asthma Education Program, 2025 summer camps for young UCare members, Keeping UCare members active, Documentation improvement: MI, UCare provider news emails, How to search UCare’s website libraries, Model of Care training, Fraud, waste and abuse reporting reminder and more. 

Read the April 2025 Health Lines.

Authorization and notification requirements update

Effective June 1, 2025, UCare will make several changes to the prior authorization and notification grids.

See the April 8 Provider Bulletin for details. 


Appointment availability assessments

From May 12 through June 30, UCare will call provider locations to assess appointment availability. 

See the April 7 Provider Bulletin for details. 

 

New Minnesota provider qualifications for Board-Certified Behavior Analysts (BCBA) requires licensing by state

Effective Jan. 1, 2025, Minnesota state law updated provider qualifications for BCBAs requiring them to be Licensed Behavioral Analysts (LBA). BCBAs are now required to be independently licensed and enrolled in Minnesota Health Care Programs (MHCP). As a result of the change, BCBA providers also must be credentialed with UCare to see UCare members.

See the Feb. 14 Provider Bulletin for details. 

2025 Q1 UCare Provider Manual Released

The Q1 UCare Provider Manual was updated to reflect current business practices.

Visit the UCare Provider Manual page for the most up-to-date version.

 

Durable Medical Equipment (DME) unlisted or enhanced items and supplies reimbursement to change

Effective April 1, 2025, providers who bill for unlisted or enhanced DME equipment and supply HCPCS codes submitted with a U3 modifier for UCare Minnesota Health Care Program (MHCP) members will receive new reimbursement rates.

For details, see the Jan. 29 Provider Bulletin.

Medical Assistance (Medicaid) providers required to enroll with Minnesota Health Care Programs (MHCP) – Deadline extended for provider types requiring MHCP site visits

The 21st Century Cures Act requires states to enroll all Medical Assistance (Medicaid) providers. UCare providers who are contracted to provide services to Medical Assistance members are expected to enroll with MHCP, except for certain provider types that require a site visit from the Minnesota Department of Human Services (DHS) first. DHS has extended the enrollment requirement date to April 30, 2025, for these provider types. MHCP will conduct an announced site visit within 60 days of the referral date for the providers. These providers must complete both the enrollment process and site visit by April 30, 2025.

See the Jan. 28 Provider Bulletin for a list of provider types with an extension.