Medical Services Authorizations

Acupuncture Prior Authorization Request Form (Effective 8-8-2022)
Birth Notification Form
DHS Managed Care Service Authorization Request Process
Durable Medical Equipment/Supply Prior Authorization Form
General Prior Authorization Request Form (Not used for Behavioral Health services)
Genetic Testing Prior Authorization Form
Home Care Nursing/Private Duty Nursing Request 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 Authorization Information
Nursing Home/Swing Bed Admission/Update Form
Nursing Facility (NF) Communication Form for MSHO, MSC+, UCare Connect and UCare Connect + Medicare health plans.

Only State Public Programs & Special Needs Plans
PCA Assessment Request Form
PCA Authorization Transfer Form
PCA Provider Change Request 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 Restricted Recipient Program:
Restricted Recipient Reference Guide

Specialty Referral Form
Prescribing Privileges for PCP Partners
Restricted Recipient Program Intake Form

Special Transportation Services (STS) Certificate of Need (CON) Authorization Form

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

Universal Referral Form