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June 2023 Health Lines
Learn about the following: Provider Enrollment with Minnesota Health Care Programs, Minnesota False Claims Act Reminder, Ineligible Provider List Updated May 25, 2023, Accurate Member Information is Key to Smooth Claim Submissions, Dental Access for Members and Upcoming Holidays.
Annual Reminder: Providers Should Complete Disclosure of Ownership, Control and Management Information and Exclusions Statement for Providers Form
UCare must gather and maintain information regarding the ownership, control and management interests of all contracted providers to meet regulatory requirements. UCare collects this data through the Disclosure of Ownership, Control and Management Information and Exclusions Statement for Providers (DOO) form.
Provider offices that have not completed and submitted the DOO form to UCare within the last 36-months or those that have changes to report, should send an updated DOO form to UCare by July 31, 2023.
Inpatient Hospital Readmission Payment Policy UpdatedUCare recently updated the Inpatient Hospital Readmission Payment Policy. As part of this policy update, UCare's third-party vendor, Optum, will conduct post-payment reviews of applicable inpatient hospital admissions to assess whether the multiple hospital stays should bundle into one hospital confinement. Audits will start with claims paid July 15, 2023, and later.
See the June 1 Provider Bulletin for details.
End to COVID-19 Public Health Emergency
The COVID-19 Public Health Emergency (PHE) ended on May 11, 2023. UCare has revised its COVID-19 guidance for providers. Review UCare COVID-19 Information for Providers page for more information regarding these changes.
See the May 23 Provider Bulletin for additional details.
Appointment Availability Assessments
From May 22 through June 30, UCare is calling provider locations to assess appointment availability.
Provider Enrollment With Minnesota Health Care ProgramsUCare providers who are contracted to provide services to Medicaid members will be expected to enroll with Minnesota Health Care Programs (MHCP) starting July 17, 2023. Resources are available to help prepare for the enrollment process. See the May 17 Provider Bulletin.
Temporarily Changes to Post-Acute Care Authorization and Notification Requirements
Effective May 12, 2023, to Dec. 31, 2023, UCare is waiving prior authorization requirements for all plans before admission for Long-Term Acute Care Hospital (LTACH) and Acute Inpatient Rehabilitation (AIR).
Redeterminations and Renewals
The Minnesota Department of Human Services (DHS) has reinstated Medicaid redeterminations (or renewals) for Medical Assistance members. The renewal process started with Medical Assistance members who have a renewal date of July 1, 2023. This is the first date members could lose coverage for failing to renew their eligibility with the state and county.
UCare Provider Manual Updated for Q2 2023UCare’s 2023 Provider Manual contains critical information that providers need to know to effectively work with UCare and our members. It is important that providers reference the online manual regularly for up-to-date content. The Provider Manual has been updated to reflect current business practices.
Go to the Provider Manual.
2023 Summer Camps Available for Young UCare Members
This summer, UCare will team up with Minnesota camps to offer opportunities for young UCare members in Prepaid Medical Assistance Program (PMAP) and MinnesotaCare plans.
Updated Prior Authorization Criteria for Drugs on the IFP Formulary
Starting June 1, 2023, UCare is updating prior authorization criteria for two drugs that are on the UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview formulary.
Discussing a Pre-Service Denial With a Reviewer
Beginning May 1, 2023, practitioners will have 14 calendar days from the denial notice date of an authorization to initiate a discussion of a pre-service authorization denial decision.
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.