Authorization
View Medical Authorization Requirements & Forms By Plan
View Mental Health & SUD Authorization Requirements & Forms By Plan
*UCare Medicare Plans include Aware, Classic, Complete, Essentials Rx, Prime, Standard, Value and Value Plus,
Advocate Choice, Advocate Choice Plus and UCare Medicare Supplement.
UCare Individual & Family Plans include Core, Bronze, Bronze HSA, Silver, Silver HSA and Gold; and
UCare Individual & Family Plans with M Health Fairview Bronze, Bronze HSA, Silver, Silver HSA and Gold.
Resources & Information
2022 Medical Services Authorization & Notification Grids:
2022 Medical Services Authorization & Notification Requirements -
UCare Medicare Plans and UCare Medicare with M Health Fairview & North Memorial
2022 Medical Services Authorization & Notification Requirements -
EssentiaCare
2022 Medical Services Authorization & Notification Requirements -
State Public Programs
2022 Medical Services Authorization & Notification Requirements -
Special Needs Plans
2022 Medical Services Authorization & Notification Requirements -
UCare Individual and Family Plans,
UCare Individual and Family Plans with M Health Fairview
2022 Mental Health and Substance Use Disorder Services Authorization & Notification Grids:
2022 Mental Health and Substance Use Disorder Services Authorization & Notification Requirements -
Medicare
2022 Mental Health and Substance Use Disorder Services Authorization & Notification Requirements -
Medical Assistance
2022 Mental Health and Substance Use Disorder Services Authorization & Notification Requirements -
UCare Individual and Family Plans,
UCare Individual and Family Plans with M Health Fairview
2021 Medical Services Authorization & Notification Grids:
2021 Medical Services Authorization & Notification Requirements -
UCare Medicare Plans and UCare Medicare with M Health Fairview & North Memorial
2021 Medical Services Authorization & Notification Requirements -
EssentiaCare
2021 Medical Services Authorization & Notification Requirements -
State Public Programs
2021 Medical Services Authorization & Notification Requirements -
Special Needs Plans
2021 Medical Services Authorization & Notification Requirements -
UCare Individual and Family Plans,
UCare Individual and Family Plans with M Health Fairview
2021 Mental Health and Substance Use Disorder Services Authorization & Notification Grids:
2021 Mental Health and Substance Use Disorder Services Authorization & Notification Requirements -
Medicare
2021 Mental Health and Substance Use Disorder Services Authorization & Notification Requirements -
Medical Assistance
2021 Mental Health and Substance Use Disorder Services Authorization & Notification Requirements -
UCare Individual and Family Plans,
UCare Individual and Family Plans with M Health Fairview
Medical Injectable Drug Authorization & Notification Requirements:
Medical Injectable Drug Authorization List
Find medical injectable drug prior authorization resources and forms to request authorizations on our Pharmacy page for all UCare health plans.
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.
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 Authorizations:
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 - PT, OT, ST Authorization:
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
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 2021 Medical Authorization and Notification grids.
Medical Necessity Criteria Request Form
Find drug coverage for each UCare health plan and forms to request exceptions or authorizations on our Pharmacy page.
Find medical injectable drug prior authorization information for each UCare health plan and forms to request authorizations on our Pharmacy page.
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.
Restricted Recipient Program
Restricted Recipient Reference Guide
Minnesota Restricted Recipient Program - State Public Programs
The forms below may be used when referring members to the UCare Restricted Recipient Program:
Specialty Referral Form
Prescribing Privileges for PCP Partners
Restricted Recipient Program Intake Form
Restricted Member Program - Individual & Family Plans
The forms below may be used when referring members to the Individual & Family Plans Restricted Member Program:
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
This form is intended to communicate patient referrals between medical and behavioral health providers.
Universal Referral Form