Provider Forms
Frequently used forms
The following are forms for providers who work with UCare. Additional forms, information and instruction may be found on the individual pages related to relevant topics.
Medical Services
AIR/LTACH Admission Notification Form
Durable Medical Equipment/Supply Prior Authorization Form
General Prior Authorization Request Form (Not used for Medical Drug authorization requests)
Genetic Testing Prior Authorization Form
Hospice Election Form
Inpatient Notification Form
NICU Notification Form
Rare Disease Prior Authorization Form
Transplant Prior Authorization Form
Universal Health Plan/Home Health Agency Prior Authorization Request Form
Mental Health and Substance Use Disorder Services
Inpatient Notification Form
MHSUD General Services Form
MHSUD Residential Authorization Form
MHSUD Out-of-Network Prior Authorization Form
Care Management Referral Form - PDF
Care Management Referral Form - Word
Complex Case Management Referral Form - PDF
Complex Case Management Referral Form - Word
Medical Necessity Criteria Request Form
Mental Health & Substance Use Disorder Case Management Referral Form
Intensive Community Based Services (ICBS) Referral Form
Add or update a facility or location form
Advance Recipient Notice of Non-covered Service/Item (DHS)
Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) - If you would like to begin receiving funds and remits electronically, complete the Provider Payment and Remittance Request Form within the UCare Provider Portal.
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)
W-9
Credentialing and Recredentialing
Initial Credentialing Application
MN Uniform Facility Credentialing Application
Uniform Re-Credentialing Application
Join Our Network
FDR Attestation
FDR Compliance Program Requirements
Site/Practitioner List
Provider Directory & Subdirectory Questionnaire
UCare Contract Intake Form
W-9
Manage Your Information - Add/Change/Term
Electronic Form submissions through July 21, 2025: UCare recently changed some of its electronically submitted forms. These forms will temporarily need to be submitted via a designated email. Providers who submitted an electronic form before or on July 21 and received a confirmation number do not need to resubmit the form. All forms will be processed in the order received.
Add a facility or location
Add or change a non-credentialed practitioner
Change or update your facility profile (tax ID, legal name, ownership, address, phone, NPI)
Disclosure of Ownership Form
MN Uniform Practitioner Change Form
PCA UMPI Change Form
Remove an organization or close a location
UCare Provider NDA Attestation
UCare Continuity of Care Document
Medical Injectable Drug Authorization form
Minnesota Uniform Form for Prescription Drug Prior Authorization (PA) Requests and Formulary Exceptions
Non-participating Provider Request Form
Other forms for Pharmacy are available based by product, please see the specific pharmacy page for the exact forms.
Authorization for PCP Partners in Clinic
Restricted Recipient Program Intake Form
UCare Individual & Family Plans Medical Referral for UCare Restricted Member Enrollee
UCare Individual & Family Plans Prescribing Privileges for PCP Partners
UCare Individual & Family Plans Restricted Member Program Intake Form
Universal Referral Form