UCare introduces new trading partner for electronic transactions

UCare is now working with Availity as its new trading partner for electronic data interchange (EDI) services. Providers still have their choice of clearinghouse. However, either providers or their clearinghouse must enroll with Availity for EDI transactions with UCare as of Dec. 17, 2024.

See the Dec. 13 Provider Bulletin for details. 

2025 code and editing updates

New codes have been identified for 2025 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. UCare uses multiple automated claims editing and pricing applications to ensure consistent and accurate processing of claims. Providers should allow time for the updates to be put into production to avoid resubmissions, adjustments or incorrect editing of the claims. Update and implementation dates vary.

See the Dec. 5 Provider Bulletin for details.

December 2024 Health Lines

Learn about the following: 2025 authorization and notification grids now available, updates to authorization forms, 2025 pharmacy benefit information, 2025 tip sheets, switch patients to Humira biosimilars before 2025, Medicaid providers are required to enroll with MHCP, Ineligible Provider List updated and more. 

Read the December 2024 Health Lines.

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. 

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. 

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