Authorization & Notification

Screening, Brief Intervention and Referral to Treatment (SBIRT) Update

Effective Jan. 1, 2023, UCare members enrolled in Prepaid Medical Assistance Program, MinnesotaCare, UCare’s Minnesota Senior Health Options, Minnesota Senior Care Plus, UCare Connect and UCare Connect + Medicare are eligible to access substance use disorder (SUD) services after completing a SUD screening through the SBIRT process.

See the January 30 Provider Bulletin for details. 

UCare Announces Updates to Transplant Services Notification Form and Process

UCare has updated the Transplant Services Notification Form and process. The updates align with the 2023 Authorization Grids for all product lines. UCare requires notification at three junctures in a member’s transplant journey.

See the January 23 Provider Bulletin for details.

Updated Prior Authorization Criteria for Drugs on the IFP Formulary

Starting March 1, 2023, UCare is updating prior authorization criteria for three drugs that are on the UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview formulary.

See the January 20 Provider Bulletin for details.

January 2023 Health Lines

Learn about the following: Pharmacy 2023 Authorization Benefit Information, New Provider Portal Available, New Coverage Policy Added, Annual Review of Coverage Policies, Addressing Disability and Creating Access Training Available, Rural Emergency Hospitals: New Medicare Provider Type, Health Promotion 2023 Updates and New Benefits, Leaders Honored by Twin Cities Business, Reminder: Notify UCare of Changes in Ownership and more.  

Read the January 2023 Health Lines.

2023 Code and Editing Updates

New codes have been identified for 2023 and will be accepted into the UCare system. New codes will have published effective dates but are subject to the editing update and implementation dates. 

Please see the December 8 Provider Bulletin for additional details. 

CMS Crossover Durable Medical Equipment (DME) Claims Not Sent to UCare for Payment

In early 2022, UCare had a connectivity issue with the Centers for Medicare & Medicaid Services (CMS) related to crossover claims. UCare and CMS remedied this issue beginning April 17, 2022. In July 2022, CMS and UCare coordinated a recovery process to resend crossover claims missing from the early part of 2022. Based on recent claims inquiries from DME providers, UCare and CMS found a gap in the recovery process. UCare has confirmed these claims were not included by CMS in the recovery process. UCare has also confirmed that DME claims cannot be included in a similar recovery process.

Please see the December 7 Provider Bulletin for more information. 

340B Drug Payment Changes

UCare follows the Centers for Medicare and Medicaid Services (CMS) billing requirements and reimbursement guidelines for certain drugs purchased under the 340B Drug Pricing Program. CMS recently published information regarding payment changes for these drugs in accordance with the ruling from the United States District Court for the District of Columbia. UCare has implemented these payment changes. 

Please see the December 7 Provider Bulletin for details. 

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.

See the 2023 Formulary Bulletin.

Medical Benefit Drug Prior Authorization for 2023

Medical Benefit Drug Prior Authorization for 2023 and Preferred Product Step Therapy Information now available. 

See the November 15 Provider Bulletin for details.

UCare's 2023 Authorization & Notification Grids

The UCare 2023 authorization and notification requirements are now available.

For a list of changes, please see the November 9 Provider Bulletin. 

View the 2023 authorization grids in the Resources and Information section of the Authorizations page.

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. 

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.

See the September 1 Provider Bulletin for details. 

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.

See the Critical Business Reminders page for updates.

Information on UCare’s New Claims System