UCare Provider Portal
Frequently Asked Questions
What is the 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 some features of the Provider Portal?
- The portal is organized around the Tax ID Number (TIN), National Provider Identifier (NPI) and site locations.
- One Provider Admin per TIN is required.
- The Provider Admin can add users and provision them to the TINs, Group NPIs and Site Locations within their organization.
- The portal has a two-step 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 from the 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 can a Provider request updates?
Providers can request updates by using the Provider Update Tool or PUT, available on our website. The Provider Update Tool (PUT) takes the place of online forms like the Facility Add Form (FAF) and the Facility Change Form (FCF) for contracted providers. Non-contracted providers can continue to use the online forms; however, contracted providers will be expected to access the portal and submit changes via PUT. PUT has two options, Manage Practitioners and Manage Site Locations. PUT can be used to add, change and terminate practitioners or site locations. PUT cannot be used to join the UCare network or for credentialing. Refer to the Our Network page for more information.
See more FAQs specific to PUT further down this page.
Where can I find the user guide for the general Provider User?
Here is a link to the Provider Portal User Guide.
(See the Provider Admin User Guide for more information.)
What is in the Provider Admin's role for the portal?
The Provider Admin will manage all users for the portal, including provisioning access for each user from the facility and (if applicable) Third Party Billers. This includes removing access if changes occur.
What are the different security roles a user can hold in the 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 – 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.
If I create a Financial User, will they have the same functional ability as a Portal User?
Yes. The roles are the same, except the Financial User can also view the Reports in the Resource Center. UCare has established a primary Tax ID for each Group or Organization. A Financial User will need to be set up to have access to the primary TIN to have access to the reports.
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.
Can I add a User from a third-party entity?
The decision to add a User from a third-party entity is up to your organization. Admins are able to set up a new user from a third-party entity. UCare needs to have, on file, a Third-Party Authorization form before a third-party User can be added. Access the form here. When adding a user from a third-party, we ask that you use “Third-Party” for the user job title.
Where can I find the Provider Admin user guide?
There are two guides available. There is a Provider Admin Set Up Guide that explains how a Provider Admin will typically be set up their account on the Portal. The other is the Provider Admin User Guide that explains how the Provider Admin will provision users for their organization. Both guides are available on the portal login page.
The link is available on the UCare Provider website. Go to ucare.org/providers. Click the button labeled Visit Join Our Network, then under Provider Search click ‘Learn more’.
Non-Contracted providers can use the Non-Credentialed Practitioner (NCP) add form if credentialing is not required for their provider type or a Facility Add or Facility Change form when changes are needed. The forms are available on the Manage Your Information webpage.
How do I access the forms to request a change in Electronic Fund Transfers (EFT) or Electronic Remittance Advice (ERA)?
To request an EFT or ERA, in the portal go to Resource Center, then click Resources. On the Resources page, use the link under Provider Payment and Remittance Request Form.
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.
The financial reports in the portal will be available for up to 18 months from the date of the report. If you need to save a copy of the financial reports to your computer, we encourage you to do so right away.
Who can see the reports in the portal?
Only users who are given the security role of Financial User can see the reports.
What if I need to change the Financial User?
The Provider Admin who is responsible for assigning Financial Users for the organization can add and change the Financial User record at any time.
Who do I contact if I have questions about the report?
Contact your Provider Contract Manager. If you do not know who your contract manager is, call PAC at 612-676-3300 or 1-888-531-1493 toll-free.
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
referral to 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 incentivized 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.
Is there any training or introduction to the Provider Portal I can used to familiarize myself with how to use the system?
Yes, the demonstration introducing the Provider Portal Admin functions was recorded. You can view the recording here: https://www.youtube.com/watch?v=4c1F2Qnw_nM
Other demos will be available later.