Claims & Billing
Online Provider Claim Reconsideration Form (Use if you have a UCare Provider Portal account) Some providers are experiencing a problem accessing the form (seeing 401, 403 or 404 errors). If you are unable to access the online form, please use the Legacy Claims Reconsideration Request Form.
Online Provider Claim Reconsideration Form (Use if you do not have a UCare Provider Portal account) Some providers are experiencing a problem accessing the form (seeing 401, 403 or 404 errors). If you are unable to access the online form, please use the Legacy Claims Reconsideration Request Form.
Legacy Provider Claim Reconsideration Request Form (PDF, Fax: 612-884-2186)
Tips for Using the Online Claim Reconsideration Form
Advance Recipient Notice of Non-covered Service/Item (DHS)
Claim Attachment Cover Sheet (Fax: 612-884-2261)
The Electronic Funds Transfer (EFT)/Electronic Remittance Advice (ERA) form is now available on the Provider Portal.
Legacy Provider Portal: Once logged in, click “Provider Inquiries” and select “Provider Forms.” The form is listed on that page.
New Provider Portal: Once logged in, click "Resource Center," the Document Center will open. From there, select the "Resources" tab and open the "Provider Payment and Remittance Request Form" accordion.
Fraud, Waste and Abuse
Waiver of Liability for Non-Contracted Providers
Provider Guide: The Explanation of Payment (EOP)
Resources for Electronic Transactions
UCare's New Claim System Information
UCare offers Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA). If you would like to begin receiving funds and remits electronically, please complete the Provider Payment and Remittance Request Form within the UCare Provider Portal. If you have questions about EFT or ERA transactions, please email EFT835@ucare.org.
The standard Claims Payable Calendar displays the dates providers can expect remittance payment. Providers will receive notifications of additional temporary claim payment dates via Health Lines or Provider Bulletins.
UCare requires the corresponding taxonomy to be submitted whenever a National Provider Identification (NPI) is reported on a claim submitted directly to UCare or on claims that will crossover and be coordinated with UCare coverage. When taxonomy is not reported on a claim that includes a NPI number(s), the claim will be rejected.
- For professional claims (submitted via 837P or CMS 1500) – billing and rendering taxonomy.
- For institutional/facility claims– billing (submitted via 837I or UB04) and attending taxonomy (submitted via 837I).
- If you contract with a third party to call UCare on your behalf, we need a signed acknowledgement form on file giving UCare permission to release information. Click the link below to approve a third party.
News & Alerts
Provider News Library
UCare creates online resource for Change Healthcare/Optum outage
Change Healthcare/Optum is experiencing a nationwide network interruption. UCare is monitoring this evolving situation and has created a webpage to keep providers informed. Providers are encouraged to check the webpage regularly for updates.
Updated prior authorization criteria for drugs on the Individual and Family Plans formulary
On April 1, 2024, UCare will update prior authorization criteria for one drug or category on the UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview formulary.
See the February 16 Provider Bulletin for details.
February 2024 Health Lines
Learn about the following: Reminder: Trainings available for Minnesota Provider Screening and Enrollment Portal (MPSE), Reminder: UCare 2024 pharmacy benefit information, Interactive Voice Response (IVR) or texting program - asthma and diabetes, Human papillomavirus (HPV) vaccination and cervical cancer screening, Fall prevention, Fraud, waste and abuse reporting reminder and How to access the UCare for providers webpage.
Importance of maintaining accurate provider data
Providers are required to make sure UCare has current demographic information on their practice, available practitioners and services offered. Regularly reviewing and updating this information ensures that UCare members are using the latest data, allowing them to access care more easily.
Early Intensive Development and Behavioral Intervention (EIDBI) Claims Payment ReminderIn December 2023, the Minnesota Department of Human Services (DHS) updated EIDBI billing guidelines clarifying information regarding Comprehensive Multi-Disciplinary Evaluations (CMDE). Per the update, CMDE providers are not required to be affiliated with an EIDBI agency and do not require a Qualified Supervising Professional (QSP) to be listed on claims.
See the Jan. 4 Provider Bulletin for details.
MinnesotaCare Tax is Changing Jan. 1, 2024
Effective Jan. 1, 2024, the amount of the tax imposed on health care providers under Minn. Stat. § 295.52 (known as the “MinnesotaCare Tax”) is changing from 1.6% to 1.8% of gross revenues. As a result, the portion of provider reimbursement that represents payment by UCare for providers’ MinnesotaCare Tax expense will be adjusted accordingly, as applicable, effective for dates of service beginning Jan. 1, 2024.
2024 Code and Editing Updates
New codes have been identified for 2024 and will be accepted into the UCare system. New codes will have published effective dates but are subject to the editing update and implementation dates.
UCare to Implement Outpatient Hospital Pricing Software and Select Inpatient Post-Payment Claims ReviewUCare issues a Provider Bulletin regarding two new claim implementations. For details, please review the November 16 Provider Bulletin.
UCare to Implement Six Month Timely Filing of Claims for Minnesota Health Care Programs (MHCP) Products
The Minnesota Department of Human Services is requiring managed care organizations to immediately implement a new timely filing requirement, due to a statute change passed by the Minnesota Legislature earlier this year. As a result, UCare has updated its timely filing requirements from 12 months to six months, effective Aug. 1, 2023, for MHCP products.
UCare Selects Navitus Health Solutions as New Pharmacy Benefit Manager for 2024
Beginning Jan. 1, 2024, UCare will transition to a new Pharmacy Benefit Manager, Navitus Health Solutions. Navitus will process pharmacy claims, perform first-level prior authorization reviews, manage the pharmacy network and manage the Pharmacy Help Desk for all UCare plans.
Pharmacy Formulary and Benefit Changes for 2024
UCare shares its 2024 pharmacy formulary and updates, a reminder about Medicare Part D vaccine coverage and how it is notifying impacted members and providers of changes.
Medical Drug Prior Authorization for 2024 and Preferred Product Step Therapy Information
Care Continuum will continue to perform authorization reviews for participating providers for all lines of business in 2024. Non-participating and MultiPlan providers will submit prior authorizations directly to UCare using an updated authorization request form.
UCare Individual and Family Plans 2024 Plan Year Benefit Expansion: Doula Services
Starting Jan. 1, 2024, UCare will add coverage for doula services to UCare Individual & Family Plans (IFP) and UCare Individual & Family Plans with M Health Fairview. UCare strives to support the best birth and infant health outcomes to improve health equity.