Medical Services Authorizations
EssentiaCare
Authorization and Notification Requirements - Medical Services
Review EssentiaCare Requirements:
Forms & Information
All Products
Durable Medical Equipment/Supply Prior Authorization Form
General Prior Authorization Request Form (Not used for Behavioral Health services)
Genetic Testing Prior Authorization Form
Hospice Election Form
Transplant Notification Form
Universal Health Plan/Home Health Agency Prior Authorization Request Form
Only EssentiaCare, UCare Medicare and UCare Medicare with M Health Fairview & North Memorial Plans
Pre-Determination Request Form
Only State Public Programs & Special Needs Plans
Birth Notification Form
DHS Managed Care Service Authorization Request Process
Home Care Nursing/Private Duty Nursing Request Form
Medicaid Acupuncture Prior Authorization Request Form
For SNF Medically Necessary Private Room Requests, UCare will accept either the DHS Private Room Request Form found in the DHS Nursing Home portal or the necessary details added to the Nursing Home/Swing Bed Admission/Update Form.
Only Medicare and Individual & Family Plans
Nursing Home/Swing Bed Admission/Update Form
Only State Public Programs & Special Needs Plans
Nursing Home Authorization Information
Only MSHO, MSC+, UCare Connect and UCare Connect + Medicare Plans
Nursing Facility (NF) Communication Form
UCare has partnered with Magellan to manage the utilization and quality of its members’ outpatient and in-home rehabilitative and habilitative therapy services. You must register to access functionality that will help you with your UCare Therapy Authorizations.
Direct all authorization questions to Magellan Healthcare | 952-225-5700 or 1-888-660-4705, Fax: 1-888-656-1952
All Products
This form is intended to communicate patient referrals between medical and behavioral health providers.
Authorization Contact Information
UCare Clinical Services
Phone (local): 612-676-6705
Phone (toll free): 1-877-447-4384
Fax: 612-884-2499
Magellan Healthcare: Therapy - PT, OT, ST
Phone (local): 952-225-5700
Phone (toll free): 1-888-660-4705
Fax: 1-888-656-1952
Web: www.hsminc.com/ucare/home/
Provider Resources
Policies & Resources
View Authorization Requirements & Forms For Another Plan
*UCare Medicare Plans include Aware, Classic, Complete, Essentials Rx, Prime, Standard, Value and Value Plus,
Advocate Choice, Advocate Choice Plus and UCare Medicare Supplement.
UCare Individual & Family Plans include Core, Bronze, Bronze HSA, Silver, Silver HSA and Gold; and
UCare Individual & Family Plans with M Health Fairview Bronze, Bronze HSA, Silver, Silver HSA and Gold.