Provider News

July 2024 Health Lines

Learn about the following: Reminder: Medicaid providers are required to enroll with Minnesota Health Care Programs (MHCP), revised coverage policies added, UCare's Health Improvement team, Cecelia Health and UCare's chronic pulmonary disease (COPD) virtual support program, health coaching healthy hearts program, activity tracker plus personal emergency response system (PERS) device, how to search UCare's website libraries, UCare provider new emails, Model of Care training and fraud, waste and abuse reporting reminder. 

Read the July 2024 Health Lines.

Important reminders and updates for UCare interpreter providers

A Minnesota Department of Health (MDH) Roster ID must be included for all claims submitted to UCare for interpreter services. Interpreter claims that do not contain the information are subject to deny.

Read the June 12 Provider Bulletin for details. 

Annual reminder: Complete the Disclosure of Ownership, Control and Management Information and Exclusions Statement for Providers form

UCare must gather and maintain information regarding the ownership, control and management interests of all contracted providers to meet regulatory requirements. UCare collects this data through the Disclosure of Ownership, Control and Management Information and Exclusions Statement for Providers (DOO) form.

See the June 6 Provider Bulletin for details.

Improper diagnosis coding for acute stroke or myocardial infarction in office

UCare wants to make providers aware that claims submitted with certain diagnosis codes related to acute stroke and myocardial infarction (heart attack) when billed with an office place of service (POS 11) are considered incorrect coding and will be rejected.

See the May 31 Provider Bulletin for details.

Amendment to UCare's Provider Participation Agreement

UCare and our network of participating providers are required to follow all applicable state and federal statutes, rules and regulations. In compliance with Minn. Stat. 62Q.739, UCare is amending the indemnification section of the Provider Participation Agreement.

See the May 22 Provider Bulletin for details.

Updated prior authorization criteria for drugs on the Individual and Family Plans formulary

On July 1, 2024, UCare will update prior authorization criteria for drugs on the UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview formulary.

See the May 21 Provider Bulletin for details. 

Appointment Availability Assessments

From May 15 through June 30, UCare is calling provider locations to assess appointment availability. This assessment helps to ensure the UCare network can provide care to members in a timely manner.

See the May 16 Provider Bulletin for details. 

Upcoming Elderly Waiver provider training seminar

UCare will offer four in-person and virtual training opportunities about providing Elderly Waiver (EW) services to members. The first is June 10.

See the May 13 Provider Bulletin for more information

Billing providers that don’t require rendering provider NPI or taxonomy

There are certain billing providers that do not require a rendering provider NPI and taxonomy on the claim. Including unnecessary rendering provider information on these claims initiates a manual review and slows down the claims processing time and payment.

See the May 10 Provider Bulletin for details.

2024 Q2 UCare Provider Manual Released

The Q2 UCare Provider Manual was updated on 5/7/24 to reflect current business practices.

Visit the UCare Provider Manual page for the most up-to-date version.

 

Terminating a Third-Party Agency relationship

When providers terminate their relationship with a Third-Party Agency (TPA), it is imperative that upon termination, providers remove provisioning access in the provider portal for provider TIN(s) accessed by the TPA users within five business days.

See the May 6 Provider Bulletin for details.

Reminder: Medicaid providers required to enroll with MHCP

UCare providers who are contracted to provide services to Medicaid members are expected to enroll with MHCP by July 15, 2024, unless otherwise noted.

See the May 3 Provider Bulletin for details and exceptions.

Reminder for billing Behavioral Health Home services

Providers are reminded to follow Minnesota Health Care Programs (MHCP) guidelines when submitting claims for Behavioral Health Home (BHH) services to UCare for members in Prepaid Medical Assistance Program, MinnesotaCare, Minnesota Senior Care Plus, UCare’s Minnesota Senior Health Options, UCare Connect and UCare Connect + Medicare plans.

See the April 1 Provider Bulletin for details.

Importance of maintaining accurate Provider Directory data

Providers are required to make sure UCare has the most current demographic information on their practice, available practitioners and services offered. This information is used in the UCare Provider Directories. Accurate Provider Directory data ensures that UCare members can find the providers and services they need at the correct locations.

See the March 12 Provider Bulletin for details.

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. 

Online resource for Change Healthcare/Optum outage

Early Intensive Development and Behavioral Intervention (EIDBI) Claims Payment Reminder

In 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.

Read the Dec. 20 Provider Bulletin for details. 

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.

See the November 14 Provider Bulletin for details.

Critical Business Reminders

UCare provides Critical Business Reminders annually to update our provider network on important business information. View our updated Critical Business Reminders webpage here. You'll find updates to the credentialing and recredentialing process, pharmacy section, Complex Case Management Program referral process, utilization management (UM), affirmative statement, how to request UM criteria and obtain access to UM staff, Member Rights and Responsibilities, links to shared decision-making (SDM) resources and links to training and resources on culturally congruent care. 

See July 5 Provider Bulletin for details.