UCare's 2025 Authorization & Notification Grids

The UCare 2025 authorization and notification requirements are now available.

For a list of changes, please see the November 15 Provider Bulletin. 

View the 2025 authorization grids on the Authorizations page.

Updates on claim payment for UCare Individual and Family Plans: Greater transparency in MinnesotaCare tax payments

UCare will begin reporting tax as its own adjustment on UCare Individual and Family Plans claims effective with Jan. 1, 2025, dates of service.

See the Nov. 6 Provider Bulletin for details. 

November 2024 Health Lines

Learn about the following: 2024 UCare Provider Manual Q4 update, Ineligible Provider List updated October 18, 2024, portal navigation enhancement, November is Diabetes Awareness Month, importance of maintaining accurate Provider Directory data and upcoming holidays. 

Read the November 2024 Health Lines.

2024 Q4 UCare Provider Manual Released

The Q4 UCare Provider Manual was updated to reflect current business practices.

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

 

Important reminders and updates for UCare interpreter providers

Providers should include a Minnesota Department of Health (MDH) Roster ID for all claims submitted to UCare for face-to-face oral interpreter services. Interpreter claims that do not contain the information indicated in the bulletin may be rejected.

See the Nov. 1 Provider Bulletin for details.

Pharmacy formulary and benefit changes for 2025

UCare has released the formularies, a summary of benefit changes by product and information about authorization requests for 2025.

See the Oct. 31 Provider Bulletin for details.

Authorization and notification requirements update: Adult Rehabilitative Mental Health Services

On Jan. 1, 2025, UCare will remove prior authorization requirements for Adult Rehabilitative Mental Health Services (ARMHS) for contracted providers. Beginning Jan. 1, 2025, authorization will be required after services have exceeded certain limits.

See the Oct. 23 bulletin for full details on the change.

Medical drug prior authorization (ePA) request portal update

Beginning Oct. 1, 2024, providers will no longer be able to submit ePA requests through ExpressPath for UCare members. Providers will need to submit requests for UCare members online, through www.EviCore.com.

Read the September 3 Provider Bulletin here. 

Electronic visit verification compliance will go into effect on Sept. 1, 2024

On July 2, 2024, the Minnesota Department of Human Services (DHS) issued a notice that it will enforce electronic visit verification (EVV) compliance starting Sept. 1, 2024. EVV is required for all Medicaid personal care services, including some waiver services and home health services. Impacted UCare providers must be compliant with this direction provided by DHS.

See the August 23 Provider Bulletin for details. 

Minnesota Department of Human Services transitioning Personal Care Assistance to Community First Services and Supports

The Minnesota Department of Human Services (DHS) will begin implementing Community First Services and Supports (CFSS) Oct. 1, 2024.

See the August 16 Provider Bulletin for details. 

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.

Updated prior authorization criteria for drugs on the Individual and Family Plans formulary

On July 1, 2024, UCare will update prior authorization criteria for drugs on the UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview formulary.

See the May 21 Provider Bulletin for details. 

UCare creates online resource for Change Healthcare/Optum outage

Change Healthcare/Optum is experiencing a nationwide network interruption. UCare is monitoring this evolving situation and has created a webpage to keep providers informed. Providers are encouraged to check the webpage regularly for updates. 

Online resource for Change Healthcare/Optum outage