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Provider News Library
August 2022 Health Lines
Learn about the following: Q3 2022 Provider Manual Update, New Look for the Authorization and Notification Pages, COVID-19 Information for Providers, Ineligible Provider List Updated, Substance Use Disorder Treatment and Screening Brief Intervention and Referral to Treatment (SBIRT) Assessment Assistance, Credentialing Updates and more.
Updated Prior Authorization Criteria for Drugs on the IFP Formulary
Starting September 1, 2022, UCare is updating prior authorization criteria for five drugs that are on the UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview formulary.
Reminder: How to Handle Denials with a CARC and RARC Combination Containing LCD Denials
If a provider receives a denial with a Claim Adjustment Reason Code (CARC) and Remittance Advice Remark Code (RARC) combination that contains a Local Coverage Determination (LCD), this denial is based on National Government Services Local Coverage Determination (NGS LCD) criteria. UCare enforces these criteria.
Update: Temporary 5% Rate Increase for Personal Care Assistants (PCAs)
The Minnesota Department of Human Services (DHS) received approval from the federal Centers for Medicare & Medicaid Services (CMS) to implement a temporary 5% increase on certain service rates to help address the ongoing workforce shortage. This is intended to support the retention and recruitment of staff who directly support people.
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.
UCare Implements Virtual Hold For Providers
Beginning Thursday, June 23, providers may use virtual hold technology when calling UCare’s Provider Assistance Center (PAC).
FDA Approval of Ukoniq Withdrawn Due to Safety ConcernsDue to safety concerns, the U.S. Food and Drug Administration (FDA) announced on June 1, 2022, it has withdrawn approval for the cancer medicine Ukoniq (umbralisib).
See the June 22 Provider Bulletin for details.
UCare Updates Regarding 1115 Substance Use Disorder System Reform Demonstration
On March 24, 2022, UCare received formal notification from the Minnesota Department of Human Services (DHS) that the Centers for Medicare and Medicaid Services (CMS) approved proposed changes for the 1115 Substance User Disorder System Reform Demonstration.
UCare to Rollout New Prior Authorization Process for Acupuncture Services in August
Beginning Aug. 8, 2022, UCare’s partner, Fulcrum Health, will be performing medical necessity review on prior authorization requests for acupuncture services after the threshold limit has been met.
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.
Inappropriate Rejection of Some PCA Claims
UCare has identified that some Personal Care Assistant (PCA) claims are experiencing inappropriate rejections for 2022 dates of service.
Practitioner Credentialing and Claims Setup
UCare has updated its notification process for newly credentialed practitioners. Providers will now receive one letter confirming practitioner credentialing and claims setup instead of two. The new letter will confirm credentialing and instruct providers to wait 30 days to bill to ensure setup in our claims system has been completed. As a reminder, claims sent before the practitioner has been set up in UCare’s claims system will pend until setup is completed.
This information is also available in the May 12 Provider Bulletin.
Transportation Services for Medical Appointments
UCare offers transportation to and from medical appointments for eligible members when scheduled with at least 48 hours notice. Same-day rides or next-day rides are limited to more urgent situations.See the May 2 Provider Bulletin for details.
Updated Email Requirements for Multiple Claims Inquiries
Provider Assistance Center (PAC) updated the email submission requirements for multiple claims inquiries.
See the April 18 Provider Bulletin for details.
Authorization and Notification Requirements Update: Withdrawal Management
On April 1, 2022, UCare removed Withdrawal Management from the Mental Health and Substance Use Disorder Services Authorization and Notification requirements grid for members enrolled in State Public Programs or an Individual and Family Plan.
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.
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Rate Updates (CAH, RHC, FQHC): RateLetters@UCare.org