UCare to retire legacy Provider Portal

UCare is retiring its legacy Provider Portal. Starting Aug. 1, 2025, users will need to use the current Provider Portal instead. As a reminder, UCare will launch its Availity Provider Portal at a later date; the launch date has not yet been determined.

Learn more here. 

Requesting Community First Services and Supports (CFSS) reassessments

Beginning July 1, 2025, requests for reassessment for Personal Care Assistance (PCA) and CFSS should be sent directly to the member’s assigned UCare Minnesota Senior Care Plus or Minnesota Senior Health Options care coordinator. If a UCare member is receiving services through a disability waiver (CAC, CADI, BI, DD), providers should contact the county case manager to request assessments.

See the June 30 Provider Bulletin for details. 

UCare seeks health care providers to serve on committees

UCare seeks health care providers to serve on various committees.

See the June 18 Provider Bulletin for details. 

Mid-year reminder: Disclosure of Ownership form

Action is needed by providers who haven’t submitted in the last three years or have had changes since their last submission. See the Provider Bulletin for details.

See the June 16 Provider Bulletin for details.

Authorization and notification requirements update

Effective Aug. 1, 2025, UCare will make several changes to the prior authorization and notification grids.

See the June 12 Provider Bulletin for more details on the services, requirements and products that will see these changes.

Criteria clarification related to new Intracept authorization reviews

On June 1, 2025, UCare began requiring prior authorization for CPT codes 64628 and 64629, thermal destruction of the intraosseous basivertebral nerve (i.e., Intracept), for all products. UCare uses InterQual criteria to review these requests for medical necessity.

See the June 9 Provider Bulletin for more information about the criteria requirements for this procedure.

June 2025 Health Lines

Learn about the following: Provider Guide updated, UCare partners with Carleon for utilization management of genetic testing authorization, coding corner, UCare's provider training, quantity limit change for urine drug testing (UTD) services, Ineligible Provider List updated April 17, 2025, updates to UCare's Medical Assistance plans prior authorizations criteria, Minnesota Medicaid Department of Human Services (DHS) preferred drug list (PDL) update and more. 

Read the June 2025 Health Lines.

Billing for hearing aid or assisted listening device, supplies, accessories, not otherwise specified

Effective Aug. 1, 2025, UCare will enforce billing requirements for HCPCS code V5267 (hearing aid or assisted listening device, supplies, accessories, not otherwise specified) in alignment with the Minnesota Health Care Program (MHCP) Provider Manual.

See the June 2 Provider Bulletin for details. 

Supervising provider information

As a reminder, when submitting professional services and a supervising provider is required, enter the supervising provider’s name along with the supervising provider’s National Provider Identifier (NPI).

See the May 27 Provider Bulletin for information.

Ketamine Infusion Policy

On July 1, 2025, UCare's Ketamine IV drug policy takes effect for members in all UCare lines of business. Ketamine will not be covered for investigational uses.

See the May 15 Provider Bulletin for details.

Self-administered drug exclusion on medical benefit

Effective July 1, 2025, UCare will require self-administered drugs to be obtained through a pharmacy and not from health care providers during office or outpatient visits. Find more information on self-administered drugs and what this means for providers.

See the May 15 Provider Bulletin for details.

Medical drug predetermination review process

UCare no longer reviews predetermination requests for medical injectable drug services that do not require prior authorization for members in UCare's Medical Assistance and UCare's Individual and Family Plans lines of business.

See the May 15 Provider Bulletin for details.

Enhanced medical drug biosimilar step therapy criteria update

Effective July 1, 2025, UCare will update the biosimilar step therapy criteria within medical drug policies to require a trial of a preferred biosimilar product when all medical necessity criteria are met. The updates will be implemented for members in all lines of business.

See the May 15 Provider Bulletin for details.

Important reminders when billing Elderly Waiver (EW) services

When billing for EW services, providers should refer to the Home and community based services or waiver services chapter of the UCare Provider Manual.

See the May 8 Provider Bulletin for details. 

UCare partners with Carelon for utilization management of genetic testing authorizations

UCare has partnered with Carelon to perform utilization management review for genetic testing authorizations for dates of service July 1, 2025, and later. This change will apply to genetic testing services for members in all UCare products, except Medicare Supplement plans.

See the May 1 Provider Bulletin for details. 

Revised Claim Payment Schedule

Due to our annual State DHS payment delays and withholds in the months of May and June, we are making slight changes to our provider remit payment schedule. The June 25 and 27 remit payments will be made Thursday, July 3.

See the updated payment calendar for the latest information.

UCare to implement Two-Midnight Rule review process on inpatient hospital claim submissions

Effective immediately, UCare will review claims submitted as an inpatient hospital stay that are less than two midnights and do not appear to meet the standards as listed in the Centers for Medicare and Medicaid Services' Two-Midnight Rule. Inpatient hospital claims that fail to meet the standards will be denied for UCare's Medicare Advantage, UCare's Minnesota Senior Health Options and UCare Connect + Medicare plans.

See the April 21 Provider Bulletin for details. 

2025 Q1 UCare Provider Manual Released

The Q1 UCare Provider Manual was updated to reflect current business practices.

Visit the UCare Provider Manual page for the most up-to-date version.

 

Critical Business Reminders

UCare provides Critical Business Reminders annually to update our provider network on important business information. View our updated Critical Business Reminders webpage here. You'll find updates to the credentialing and recredentialing process, pharmacy section, Complex Case Management Program referral process, utilization management (UM), affirmative statement, how to request UM criteria and obtain access to UM staff, Member Rights and Responsibilities, links to shared decision-making (SDM) resources and links to training and resources on culturally congruent care. 

See July 12 Provider Bulletin for details.