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UCare Medicare Part D Vaccine Information
As a reminder, UCare denies claims for providers administering Part D vaccines in their clinics.
Please see the November 28 Provider Bulletin for additional details.
Addressing Disability & Creating Access Training: Understand and Remove Barriers
Providers and their staff are invited to learn how to address disability and create access in their work at a free, online CEU program sponsored by UCare. Linda Wolford, MS, and Kaitlin Desselle, MS, from Strategic Diversity Initiatives (SDI), and Mai Thor, co-facilitator and disability justice advocate, will present a disability provider training from 12 - 1 pm, Wednesday, Dec. 7, 2022, via Zoom.
Please see the Class Offerings webpage for additional details and to register.
Pharmacy Formulary and Benefit Changes for 2023
Information about the 2023 formularies and changes to benefits is now available.
Medical Benefit Drug Prior Authorization for 2023
Medical Benefit Drug Prior Authorization for 2023 and Preferred Product Step Therapy Information now available.
Updated Prior Authorization Criteria for Drugs on the IFP Formulary
Starting January 1, 2023, UCare is updating prior authorization criteria for 18 drugs that are on the UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview formulary.
November 2022 Health Lines
Learn about the following: Health Care Plan Benefit Changes for 2023, UCare Set to Launch New Provider Portal, Ageism Training Available, UCare's "A Salute to Excellence!" Celebrates 23 Providers, Ineligible Provider List Updated, Q4 2022 Provider Manual Update, COVID-19 Information for Providers, Understanding the Communities We Serve, Health Services Record Retention Requirements, Model of Care Training and Upcoming Holidays.
UCare Transitions to New Provider Portal
UCare has launched its new Provider Portal. In the coming weeks, Portal Administrators and Users will be notified to set up their accounts in the new portal.
Please see the November 7 Provider Bulletin for additional details about the new portal and what to expect during the transition.
Personal Care Assistance (PCA) Service Reminders
UCare would like to remind PCA provider agencies of requirements to help ensure providers are documenting visits correctly and that claims are paid appropriately.
FDA Announces Recall of Magnesium Citrate Saline Laxative Oral Solution
On July 25, 2022, the U.S. Food and Drug Administration announced Vi-Jon, LLC has voluntarily recalled all lots of Magnesium Citrate Saline Laxative Oral Solution, 10 fl. oz. (296 mL) due to the presence of Gluconacetobacter liquefaciens.
UPDATE on CARC and RARC For Rural Health Clinic (RHC) Carve-out Services
UCare is updating its system to report CARC of 24 and RARC of N193 in the 835-remittance advice and on the EOP for RHC claims that qualify for payment by DHS. We expect this change will improve posting of payments/adjustments from DHS for RHC carve-out services.
Medical and Pharmacy Benefit Duplicate Payments and Recoupment Process ReminderUCare performs quarterly duplicate payment audits of medical benefit and pharmacy benefit claims submitted. This quarterly audit has a lookback period of 12 months. Duplicate claims are recouped under the medical benefit or Medicare Part C and are identified on the Explanation of Payment (EOP) with CARC OA18 and RARC N522.
See the August 19 Provider Bulletin for details.
Important: New Requirement for Non-Emergency Transportation Providers Expecting Rural Urban Commuting Area (RUCA) Adjustments Add-ons
UCare applies RUCA rates when claims are billed with the member ZIP code or the pick-up location in the appropriate fields on the claims. Providers are reminded to submit this information to ensure they get the applicable RUCA enhancements.
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.
Information on UCare’s New Claims SystemSee all related Provider Bulletins outlining the changes you can expect with UCare’s new claims system. Visit the New Claims System page.
UCare to Deny Claims When Comprehensive Procedure Code is Not Applied
As a reminder, providers are required to bill the most comprehensive code for procedures versus individual (component) codes. Effective for claims received on or after June 28, 2022, UCare will apply edits to deny claims when the most comprehensive code is not billed.
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Rate Updates (CAH, RHC, FQHC): RateLetters@UCare.org