Authorization & Notification

2022 Medical Services:
UCare Medicare Plans and UCare Medicare with M Health Fairview & North Memorial
EssentiaCare
State Public Programs
Special Needs Plans
UCare Individual and Family Plans, UCare Individual and Family Plans with M Health Fairview

2022 Mental Health and Substance Use Disorder Services:
Medicare
State Public Programs
UCare Individual and Family Plans, UCare Individual and Family Plans with M Health Fairview

2021 Medical Services:
UCare Medicare Plans and UCare Medicare with M Health Fairview & North Memorial
EssentiaCare
State Public Programs
Special Needs Plans
UCare Individual and Family Plans, UCare Individual and Family Plans with M Health Fairview

2021 Mental Health and Substance Use Disorder Services:
Medicare
State Public Programs
UCare Individual and Family Plans, UCare Individual and Family Plans with M Health Fairview

The Formularies page on the UCare provider website shows which drugs are covered, as well as everything you need to request exceptions or prior authorization.

Medical Injectable Drug Authorization List

The Behavioral Health Case Management Referral Form is completed when you have a UCare PMAP, MNCare, MSHO or MSC+ member who has a complex Behavioral Health condition.

Mental Health & Substance Use Disorder Case Management Referral Form (New 5.26.20)

The Care Management Referral form is completed when you have a member/patient who you feel would benefit from care coordination services and is actively enrolled in UCare Connect, UCare Connect + Medicare, PMAP (under 65), UCare Medicare Plans or Individual & Family Plans.

Care Management Referral Form - PDF
Care Management Referral Form - Word

The Complex Case Management Referral form is completed when you have a medically complex member/patient who you feel would benefit from short term / intensive medical case management. They typically have a new critical medical event, multiple medical diagnoses with challenges or high medical costs/utilization. This program is for UCare Medicare and Individual & Family Plans and PMAP/MNCare.

Complex Case Management Referral Form - PDF
Complex Case Management Referral Form - Word

UCare works with delegated organizations to handle the following types of authorization.

Acupuncture Authorization (Effective 8-8-22):
Direct Duals and State Public Program authorization submissions to UCare's delegate, Fulcrum Health, Inc., | Fax: 763-204-8572
Fulcrum Licensed Acupuncture Policy
Medicaid Acupuncture Prior Authorization Request Form

Chiropractic Authorization:
Direct all authorization questions to UCare's delegate, Fulcrum Health, Inc. | 1-877-886-4941 (toll free)

Dental Authorization:
Direct all authorization questions to UCare's delegate, Delta Dental of Minnesota

• UCare State Public Programs: 1-855-648-1415 (toll free) or 651-768-1415
  
• UCare Medicare Plans and Institutional/Equivalent Special Needs Plan (I E SNP) (Medicare Advantage): 1-855-648-1416 (toll free) or 651-768-1416
  
• UCare Individual & Family Plans / UCare Individual & Family Plans with M Health Fairview: 1-855-648-1417 (toll free) or 651-768-1417
• EssentiaCare: 1-855-648-1416 (toll free) or 651-768-1416

Medical Injectable Drug Authorization:
Direct all authorization requests to UCare’s delegate: Care Continuum, a subsidiary of Express Scripts Online (ePA) at www.express-path.com/ | Phone: 1-800-818-6747 (toll free) | Fax: 1-877-266-1871

Therapy Authorization - Physical (PT), Occupational (OT) & Speech Therapy (ST):
Direct all authorization questions to UCare's delegate, Magellan Healthcare, Inc. | 952-225-5700, 1-888-660-4705 (toll free)|
Fax: 1-888-656-1952 

Register to access functionality for UCare therapy authorizations.

In order for services to be eligible for payment by UCare, the services must meet UCare’s standards for coverage, including medical necessity criteria. Coverage and benefits vary significantly among different UCare plans. Medical Necessity Criteria has been added to the 2022 Medical Authorization and Notification grids.

Medical Necessity Criteria Request Form  

Restricted Recipient Program
Restricted Recipient Reference Guide

Minnesota Restricted Recipient Program - State Public Programs & Special Needs Plans
Specialty Referral Form
Prescribing Privileges for PCP Partners
Restricted Recipient Program Intake Form

Restricted Member Program - Individual & Family Plans
UCare Individual & Family Plans Medical Referral for UCare Restricted Member Enrollee
UCare Individual & Family Plans Prescribing Privileges for PCP Partners
UCare Individual & Family Plans Restricted Member Program Intake Form

All Products
This form is intended to communicate patient referrals between medical and behavioral health providers.

Universal Referral Form