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
Waiver of Liability for Non-Contracted Providers
Provider Guide: The Explanation of Payment (EOP)
Resources for Electronic Transactions
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
September 2021 Health Lines
Learn about our Updated Look for UCare.org/providers, UCare Provider Portal to Be Unavailable, Joy Marsh Joins UCare as Associate Vice President, Equity and Inclusion, New UCare Coverage Policies Added, September is Falls Prevention Awareness Month, New UCare Tobacco & Nicotine Quit Program for Maternity, Reminder: UCare Medicare Part D Vaccine Information, Accurate Member Information is Key to Smooth Claim Submissions, Documentation Improvement: Stroke, Ineligible Provider List Updated August 5, 2021 and more.
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.
Updated Prior Authorization Criteria for Drugs on the IFP Formulary
Starting November 1, 2021, UCare is updating prior authorization criteria for 14 drugs that are on the UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview formulary.
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.