UCare Provider Portal FAQ
What is the New Provider Portal?
The Provider Portal is a way for providers, either contracted or not contracted with UCare, to view:
- Member eligibility and benefits
- Claims status and payment information
- Authorization status and details
What are the primary differences between the old portal and the new portal?
- The new portal is organized around the Tax ID Number (TIN), National Provider Identifier (NPI) and site locations. The older provider portal used Group Practice Numbers (GPN) to organize information. GPN is unique to UCare. The new portal is now using the industry standard of TIN and NPI to organize data and information.
- The new portal will still require a Provider Admin to add users, but in the new system they will also provision them to the TINs, Group NPIs and Site Locations within their organization. Provider Admins will add and provision Financial Users (Coming Soon).
- The new portal uses a more secure access system with multi-factor authentication (MFA).
- The new portal is cleaner looking with more white space.
Can all Providers use the Provider Portal?
Yes, all providers, whether contracted with UCare or not, can use the portal to confirm member eligibility and review status of a claim or authorization. Additional functionalities will be rolled out – some of which will be for contracted Providers only.
How long before the system times out due to inactivity?
The system will time out after 30 minutes of inactivity. To refresh the data, you will have to sign back into the portal.
Can I send a message to the Provider Assistance Center (PAC) in the new portal?
Yes, you can send messages to PAC in the new portal. You can also attach documents to your messages. The Message Center can be accessed by the envelope icon on the top right of any screen.
How long will the old portal be available after the new portal is launched?
Approximately 30 days.
After I transition to the new portal, will I still be able to view messages I have received or sent via the old portal?
No, you will not be able to see Sent or Received Messages from the old portal in the new portal; however, the old portal will be available for a short time after launch.
Where can I find the user guide for the general Provider User?
Here is a link to the user guide.
(See the Provider Admin User Guide for more information.)
Will other users from the old portal be migrated to the new portal? How will others in my organization be able to get access?
The Provider Admin will set up and maintain user access for their organization in the portal.
Which users from the old portal will be migrated to the new one?
One Admin will be migrated for each TIN to the new portal. The Admin will then set up all other users for that TIN.
What are the different security roles a user can hold in the new portal?
The portal has the following roles:
- Provider Admin - there can only be one Admin for any one Tax ID (TIN). UCare Payer Administration will grant access to the Provider Admin. Provider Admin can request access through link on the portal homepage.
- Provider Users – have access to information levels assigned by the Provider Admin (TIN/NPIs/Site Locations)
- Provider Financial Users (Coming Soon) – have access to information levels assigned by the Provider Admin in the same way a Provider User does. In addition, the Financial User may access financial reports in the Document Center.
Provider Admins will receive more information on how and when these users can be set up in the portal.
Why was the request from my biller or third-party biller denied when they requested access from the UCare Provider Portal landing page?
UCare will not give access to billers directly. We ask the Provider Admin to give access to any users (including billers or third-party billers) who need to view data.
Where can I find the Provider Admin user guide?
There are two guides available. The first explains how a Provider Admin will typically be set up once migration and portal launch is complete. The other explains how the Provider Admin will provision users for their organization. Both guides are available on the portal login page.
Where can I access the UCare Provider Directory?
The link is available on the UCare Provider website. Go to www.ucare.org/providers. Click the button labeled Visit Join Our Network, then under Provider Search click ‘Learn more’.
How do I access the Claim Reconsideration Form (CRF)?
The CRF is accessible from the Claim Detail page if the claim is paid. The form opens in a separate browser window. Complete the form then click Submit at the bottom of the page.
Why can’t I see a link to the Explanation of Payment (EOP)?
If payment has not been made, a link to an EOP will not be available.
Where will I see notifications in the new portal?
Notifications are found under the Bell icon in the upper right corner of the portal.
Will I see new notifications if they are sent while I’m logged in to the Portal?
No, you will have to log out of the portal and back in to see new notifications.
What is the UCare Pregnancy Notification Program (PNP)?
UCare is excited to have this program available to partner with clinic systems in identifying UCare
pregnant members as an upstream approach to serving and supporting our diverse membership. PNP is
one of the core components of our effort to increase early identification of pregnant members.
What are the goals of the Pregnancy Notification Program?
Our goals for the program are:
- Identify pregnant members early in the first or second trimester for UCare Maternal & Child
Health outreach - Promote full-term pregnancies and prevent low birth weight deliveries by connecting members
to UCare community resources during the early stage of pregnancy - Partner with pregnant members to fully understand their social, economic, mental health and
health needs and bridge member to neighboring community resources - Identify pregnant members with elevated health and social risk factors for the UCare high risk
perinatal case management program or other community programs that may be more
appropriate
How do we participate as a contracted partner in the Pregnancy Notification Program?
The Pregnancy Notification Form is available in the Provider Portal for all care systems to submit a
referralto UCare. For interested partners who would like to submit Pregnancy Notification Forms to
UCare regularly, we encourage contracting with UCare Pregnancy Notification Program to be
incentivized. Before a partner participates in the Incentive program, a short contract will need to be
established between UCare and the care system.
Prior to the starting as a partner within the Pregnancy Notification Program, your designated staff will
receive training on how to submit notifications to UCare.
How are partners incentivize for their referrals?
One of our goal is to identify pregnant members early in the first and second trimester of their
pregnancy. Partners will receive a $25 payment for each first and second trimester pregnancy
notification form sent to UCare. There is no payment for third trimester referrals, but we strongly
encourage you to submit these so that our members may receive outreach and resources from UCare.
When submitting the notification form, the status of the UCare member’s pregnancy trimester must be
reported as the date of the notification form submission. Eligible submissions will be compiled and paid
quarterly (April, July, Oct, Jan). No additional billing is required from the partner.
What can I expect when submitting a Pregnancy Notification Form through the Provider Portal?
As a partner in the Pregnancy Notification program, your OB providers (or staff designated by your site)
will be asked to submit timely pregnancy notification referrals to UCare via the online Pregnancy
Notification form, found on the UCare Provider Portal.
- For access to the Provider Portal, your UCare Provider Portal Administrator will need to create a
user account for your designated providers. UCare will provide you with the contact for your
facility’s Administrator for set up. - To access the form, log in to the UCare Provider Portal > Provider Inquiries tab > Pregnancy
Notification Form. Your submitting provider will receive a confirmation email for each
notification received by UCare.
Types of questions on the notification form:
- Member’s contact information and UCare ID
- Member’s OB history and current pregnancy status
- Member’s medical and social risk factors
- Provider’s assessment of pregnancy risk
- Provider’s contact information
Who can I refer through the Pregnancy Notification Program?
Partners can submit a notification form for any pregnant and postpartum (up to 10 weeks) UCare
members through the Provider Portal. UCare incentivize for first and second trimester referrals, but we
strongly encourage submitting third trimester pregnancy so UCare can support the member.
Once a Pregnancy Notification Form is submitted, how does UCare use this information to connect
with pregnant members?
UCare Maternal & Child Health team will process the PNP forms on a regular basis. With the information
gathered from the clinic system, our dedicated staff will provide a telephone outreach to the members.
We will go through a thorough assessment to fully understand and identify any UCare resources and
community needs to optimize and support the health of our members.