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. Once logged in, click “Provider Inquiries” and select “Provider Forms.” The form is listed on that page.
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).
Visit the Non-Contracted Provider Resources webpage for more information.
- 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.
Provider Notification/Change/Update/Termination Third-Party Agreement Notification form
News & Alerts
Provider News Library
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Discussing a Pre-Service Denial With a Reviewer
Beginning May 1, 2023, practitioners will have 14 calendar days from the denial notice date of an authorization to initiate a discussion of a pre-service authorization denial decision.
March 2023 Health Lines
Learn about the following: UCare Achieves NCQA Health Equity Accreditation for Medicaid Products, Provider Portal Access, When to Prescribe a Biosimilar, Keeping UCare Members Active and Healthy, Fraud, Waste and Abuse Reporting Reminder.
2023 Editing Update for Laboratory Services
Beginning April 1, 2023, for all products, UCare will deny referred laboratory claims with dates of service Jan. 1, 2019, or later when a claim is received by both a reference laboratory and a referring laboratory for the same member, date of service and procedure code.
Updated Prior Authorization Criteria for Drugs on the IFP Formulary
Starting April 1, 2023, UCare is updating prior authorization criteria for three drugs that are on the UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview formulary.
UCare Provider Manual Updated for 2023UCare’s 2023 Provider Manual contains critical information that providers need to know to effectively work with UCare and our members. It is important that providers reference the online manual regularly for up-to-date content. The Provider Manual has been updated to reflect current business practices.
Go to the Provider Manual.
Screening, Brief Intervention and Referral to Treatment (SBIRT) Update
Effective Jan. 1, 2023, UCare members enrolled in Prepaid Medical Assistance Program, MinnesotaCare, UCare’s Minnesota Senior Health Options, Minnesota Senior Care Plus, UCare Connect and UCare Connect + Medicare are eligible to access substance use disorder (SUD) services after completing a SUD screening through the SBIRT process.
UCare Announces Updates to Transplant Services Notification Form and Process
UCare has updated the Transplant Services Notification Form and process. The updates align with the 2023 Authorization Grids for all product lines. UCare requires notification at three junctures in a member’s transplant journey.
2023 Code and Editing Updates
New codes have been identified for 2023 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.
Please see the December 8 Provider Bulletin for additional details.
CMS Crossover Durable Medical Equipment (DME) Claims Not Sent to UCare for Payment
In early 2022, UCare had a connectivity issue with the Centers for Medicare & Medicaid Services (CMS) related to crossover claims. UCare and CMS remedied this issue beginning April 17, 2022. In July 2022, CMS and UCare coordinated a recovery process to resend crossover claims missing from the early part of 2022. Based on recent claims inquiries from DME providers, UCare and CMS found a gap in the recovery process. UCare has confirmed these claims were not included by CMS in the recovery process. UCare has also confirmed that DME claims cannot be included in a similar recovery process.
Please see the December 7 Provider Bulletin for more information.
340B Drug Payment Changes
UCare follows the Centers for Medicare and Medicaid Services (CMS) billing requirements and reimbursement guidelines for certain drugs purchased under the 340B Drug Pricing Program. CMS recently published information regarding payment changes for these drugs in accordance with the ruling from the United States District Court for the District of Columbia. UCare has implemented these payment changes.
UCare Medicare Part D Vaccine Information
As a reminder, UCare denies claims for providers administering Part D vaccines in their clinics.
Please see the November 28 Provider Bulletin for additional details.
Pharmacy Formulary and Benefit Changes for 2023
Information about the 2023 formularies and changes to benefits is now available.
Medical Benefit Drug Prior Authorization for 2023
Medical Benefit Drug Prior Authorization for 2023 and Preferred Product Step Therapy Information now available.
UCare's 2023 Authorization & Notification Grids
The UCare 2023 authorization and notification requirements are now available.
For a list of changes, please see the November 9 Provider Bulletin.
View the 2023 authorization grids in the Resources and Information section of the Authorizations page.
UCare Transitions to New Provider Portal
UCare has launched its new Provider Portal. In the coming weeks, Portal Administrators and Users will be notified to set up their accounts in the new portal.
Please see the November 7 Provider Bulletin for additional details about the new portal and what to expect during the transition.
Critical Business Reminders
UCare informs providers of critical business reminders for the Credentialing and Recredentialing Process, Pharmacy, Complex Case Management Process, Utilization Management Information, Member Rights and Responsibilities, Practitioner Support Shared Decision-Making Aids and Clinical Practice Guidelines.