Medical Services Authorizations

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

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.

Nursing Home/Swing Bed Admission/Update 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

The forms below may be used when referring members to the UCare Individual & Family Plans Restricted Member Program:

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

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

Universal Referral Form