Claims & Billing
Online Provider Claim Reconsideration Form (Use if you have a UCare Provider Portal account)
Online Provider Claim Reconsideration Form (Use if you do not have a UCare Provider Portal account)
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
Gender Identify Form
New Claims System
Provider Guide: The Explanation of Payment (EOP)
Resources for Electronic Transactions
Waiver of Liability for Non-Contracted Providers
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.
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).
Minnesota based non-contracted providers who deliver services to a UCare member will need to follow the process below before submitting a claim to UCare:
- Submit the Add or update a facility or location form to get enrolled in UCare’s payment system. A confirmation number will be provided confirming your submission.
- Within 30 business days you will receive an email notification from us confirming you have been added to UCare’s payment system.
- Submit your claim(s) electronically to UCare.
- Guidance for electronic claim submission is provided in Electronic Data Interchange chapter of the UCare Provider Manual.
- UCare requires Healthcare Provider Taxonomy Code Sets (HPTC), maintained by the National Uniform Claim Committee (NUCC), be included on all claims. For more information see Electronic Data Interchange chapter in the UCare Provider Manual.
- This process does not add your organization to UCare's contracted provider network. Please see “Join Our Network" if interested in becoming a contracted provider with UCare.
Non-contracted providers who practice outside of Minnesota but deliver services to a UCare member will need to follow the mail or online process listed below before submitting a claim to UCare:
- UCare requires Healthcare Provider Taxonomy Code Sets (HPTC), maintained by the National Uniform Claim Committee (NUCC), be included on all claims.
- This process does not add your organization to UCare's contracted provider network. Please see the “Join Our Network” page if interested in becoming a UCare contracted provider.
- Send a copy of the paper claim(s), along with completed W-9 to:
P.O. Box 70
Minneapolis, MN 55440-0070
Click here to download a Printable W-9.
- Guidance for paper claims submission is provided in Claims & Payment chapter of UCare’s Provider Manual.
- Submit the Add or update facility or location form to get enrolled in UCare's payment system. A confirmation number will be provided confirming your submission.
- Within 30 business days you will receive an email notification from us confirming you have been added to UCare's payment system.
- Submit your claim(s) electronically to UCare. Guidance for electronic claims submission is provided in Electronic Data Interchange chapter of UCare's Provider Manual.
- If you contract with a third-party biller 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 biller.
Provider Notification/Change/Update/Termination Third-Party Agreement
News & Alerts
Provider News Library
Updates and Reminders to Avoid Claim and Claim Line DenialsIn preparation for the final stage of our new claims system implementation, UCare analyzed claim submission patterns against published billing standards and guidance, as well as UCare-specific requirements published in the Provider Manual. The new claims system automates a greater portion of billing-related edits than UCare’s legacy system. As a result, providers may see much more consistency in their claim and claim line denials beginning in 2022.
See the January 18 Provider Bulletin for more details.
Updated Prior Authorization Criteria for Drugs on the IFP Formulary
Starting March 1, 2022, UCare is updating prior authorization criteria for 22 drugs that are on the UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview formulary.
January 2022 Health Lines
Learn about the New Claims System Implementation, No Surprises Act Began Jan. 1, 2022, New Coverage Policies and Annual Review Added, Medical Necessity Guidelines, Flu Vaccine Reminder, New Health Promotion Programs for 2022, Documentation Improvement: Annual Evaluation, Ineligible Provider List Updated Jan. 4, 2022, Accurate Member Information is Key to Smooth Claim Submissions, Upcoming Holidays and more.
UCare Claims Rejection Analysis, Reminders and Requests
UCare began transitioning to a new claims system in January 2019. Throughout the implementation cycle of each product into the new claims system, UCare analyzed common reasons for claims rejections, claims denials and claims appeals. As UCare begins processing claims for the largest segment of our business – Prepaid Medical Assistance Plans, MinnesotaCare, UCare Connect, Minnesota Senior Care Plus, UCare’s Minnesota Senior Health Options and UCare Connect + Medicare, there is a greater likelihood provider groups will see an increase in claims rejections.
See the January 6 Provider Bulletin for a summary of common errors and tips for how to avoid them.
Specialty Provider Referrals for Restricted Recipients
Beginning Jan. 1, 2022, UCare’s Restricted Recipient Program (RRP) will only accept specialty provider referrals that were submitted within 90 days of the service being rendered.
See the Dec. 20, 2021 Provider Bulletin for more information.
UCare Welcomes Former Blue Plus Members From Ramsey and Scott CountiesOn Jan. 1, 2022, UCare will welcome former Blue Plus members from Ramsey and Scott counties to its Prepaid Medical Assistance Plan (PMAP) and MinnesotaCare plans. Blue Plus will no longer be an option for these plans in Ramsey and Scott counties in 2022, and former Blue Plus members may elect or be defaulted to UCare’s plan.
See the Dec. 17, 2021 Provider Bulletin for more information.
Important Reminders About UCare’s Taxonomy Requirements
UCare relies on provider-submitted taxonomy for accurate and timely claims processing. As UCare moves to our new claims system, it is important to remind providers of several of the key taxonomy requirements to support claims processing.
See the Dec. 16, 2021 Provider Bulletin for more information.
No Surprises Act
Federal legislation titled the No Surprises Act (NSA) takes effect beginning Jan. 1, 2022.
See the Dec. 15, 2021 Provider Bulletin for more information.
2022 Code and Editing UpdatesNew codes have been identified for 2022 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.
See the Dec. 10 Provider Bulletin for more information.
UCare's 2022 Authorization & Notification Grids
The UCare 2022 authorization and notification requirements are now available.
View the 2022 auth grids in the Resources and Information section of the Authorizations page.
Changes Affecting Claims Submissions for UCare Medicaid and Integrated Duals Plans Beginning Jan. 1, 2022UCare is continuing to implement its new claims system. Effective Jan. 1, 2022, Prepaid Medical Assistance Program, MinnesotaCare, UCare Connect, UCare Connect + Medicare, Minnesota Senior Care Plus and UCare’s Minnesota Senior Health Options will have a new Payer ID and Member ID and format.
See the Oct. 28, 2021 Provider Bulletin for more information.
Medical and Pharmacy Benefit Duplicate Payments and Recoupment Process
Effective Oct. 1, 2021, UCare began performing duplicate payment audits of medical benefit and pharmacy benefit claims.
See the Oct. 15 Provider Bulletin for more information.
FDA Announces Chantix Recall
On Sept. 16, 2021, Pfizer announced a voluntary recall of all lots of Chantix 0.5 mg and 1 mg tablets to the patient (consumer/user) level. Patients should continue taking Chantix until they consult with their health care professional who can prescribe a replacement.
UCare’s pharmacy department will send letters to impacted members.
See the Oct. 14 Provider Bulletin for details.
Quantity Limits (QL) Updated for Continuous Glucose Monitors on All UCare Formularies
Effective Sept. 1, 2021, quantity limits for continuous glucose monitor products will be updated.
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.
Authorization and Notification Requirements Update:Outpatient Substance Use Disorder Services
Effective immediately, UCare will return to approving notifications for up to six months of services for outpatient subsstance use disorder (SUD) services for individual/group (H2035 or H2035HQ).
See the April 26 bulletin for details.
Changes to the Payment and Remittance Selection ProcessEffective immediately, UCare is changing the process to request updates to the provider’s payment and remittance selections.
Read the Dec. 18 bulletin for additional details on the changes.