Medical Services Authorizations

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.

Universal Referral Form