Non-Contracted Provider
Resources for working with UCare members.
Additional resources are available for UCare's Elderly Waiver (EW) and Housing Stabilization Services (HSS) on the Training & Education page.
General Claim Requirement Information
For first time claim submission, please review on the Claims & Billing page and the UCare Provider Manual. These resources include information on billing, remittances, taxonomy, forms, links and more. Please note, some non-contracted providers are required to be registered with the state of Minnesota (i.e., EW and HSS).
Minnesota providers are required to submit all claims electronically through a clearinghouse. Claims may be submitted electronically or on paper by out of state providers.
Guidance for electronic claims submission is provided in the Electronic Data Interchange chapter of the UCare Provider Manual.
Electronic Claims Submitters - Providers must be enrolled with UCare
- Complete and submit the Facility Location Add Form to get enrolled in UCare's payment system. A confirmation number will be provided confirming your submission.
- We require W-9 completion. Please complete the W-9 section within this form.
- Within 30 business days you will receive an email notification from us confirming you have been added to UCare’s payment system.
- Submit your claim(s) electronically to UCare.
Clearinghouse Information
A clearinghouse allows you to submit secure claims electronically. They scrub the claim for errors, then securely transmit the electronic claim to the insurance payer.
HealthEC is a free clearinghouse established to meet AUC guidelines for Minnesota electronic billing requirements.
- To register, visit MN E-Connect/Health EC Log In
- UCare Payer ID: 55413
- Contact Information: 1-877-444-7194 or email: support@healthec.com
For more information visit, Resources for Electronic Transactions. If you have questions about EDI transactions, please email EDISupport@ucare.org.
Paper Claim Submitters (available for non-Minnesota providers only)
- Mail a copy of the paper claim(s), along with completed W-9 to:
UCare
Attention: Claims
P.O. Box 70
Minneapolis, MN 55440-0070
Click here to download a Printable W-9. - Guidance for paper claims submission is provided in Claims & Payment chapter of UCare’s Provider Manual.
Important Notes
- UCare requires the corresponding taxonomy to be submitted whenever a National Provider Identification (NPI) is reported on a claim submitted directly to UCare or on claims that will crossover and be coordinated with UCare coverage. When taxonomy is not reported on a claim that includes a NPI number(s), the claim will be rejected.
- For professional claims (submitted via 837P or CMS 1500) – billing and rendering taxonomy.
- For institutional/facility claims – billing (submitted via 837I or UB04) and attending taxonomy (submitted via 837I).
- Taxonomy FAQs
- This process does not add your organization to UCare's contracted provider network. Please see the Join Our Network page if interested in becoming a UCare contracted provider.
UCare’s Non-Contracted Provider Payment Information
When submitting claims follow Department of Humans Services (DHS) and the Centers for Medicare & Medicaid Services (CMS) and standard billing guidelines. UCare reimbursement will be based on DHS and CMS guidelines, Federal and State regulatory requirements.
DHS Provider Manual for Minnesota Health Care Programs
Medicare Manuals
Claim Reconsiderations (Provider Appeals)
Resources and forms for Claims Reconsideration are available on the Claims & Billing page under Forms & Links.
For detailed guidance see the Provider Manual, go to the Claims chapter and review the Non-Contracted Provider Appeal Process section.
Payment and Remittance Information
You must have access to the UCare Provider Portalto request Electronic Payment and Remittance from UCare. Provider Portal access also allows you to check member eligibility and view claims, EOPs and authorizations.
Third-Party Billing
If you contract with a third-party biller to call UCare on your behalf, we need a signed acknowledgement form on file giving UCare permission to release information. Click the link below to approve a third-party biller.
Provider Notification/Change/Update/Termination Third-Party Agreement
Contact the Provider Assistance Center at 612-676-3300 or 1-888-531-1493 toll-free for guidance on prior authorization requirements, member eligibility and benefit information.
The UCare Provider Portal is a secure website that allows your organization to access information needed to work with UCare members. You can check member eligibility and view claims, EOPs and authorizations. You must be enrolled in the UCare Claim Payment System to be granted access to the UCare Provider Portal.
Visit the Pharmacy page for the following:
- Drug coverage information by UCare plan
- Medical injectable drug prior authorization information by UCare plan
- Formulary information by UCare plan
- Forms to request exceptions or authorizations
Learn more about Real-time Part D Vaccine claims using TransactRX.
Ensure that UCare has accurate information for your organization, location and service providers.
Manage Your Information
Advance Recipient Notice of Non-covered Service/Item (DHS)
Claim Attachment Cover Sheet (Fax: 612-884-2261)
DHS Provider Manual for Minnesota Health Care Programs
Fraud, Waste and Abuse
Medicare Manuals
MN AUC Provider Eligibility Verification Best Practice
Resources for Electronic Transactions
UCare Provider Manual
Waiver of Liability for Non-Contracted Providers
What are pass-through services?
Approval-option services, often referred to as “pass-through” services, allow qualified vendors who are not enrolled with Minnesota Health Care Programs (MHCP) to provide services to UCare members.
Counties act as the lead agency and are responsible for approving and overseeing the delivery of all approval-option services and vendors. Approved vendors are paid directly by the lead agency.
Lead agencies must submit authorization requests and claims to UCare using the UMPI or NPI that the Minnesota Department of Human Services (DHS) associates with Elderly Waiver (EW) services.
More information is available from the DHS: Lead agency oversight of waiver/AC approval-option service vendors
Informing UCare of your pass-through services
Counties are required to complete the County Pass Through Provider List and submit it to providerdatavalidation@ucare.org, notifying UCare of approved vendors.
You will receive a confirmation email from UCare upon receipt.
Billing for pass-through services
Important claim reminders:
- Use the UMPI or NPI that the Minnesota DHS associates with Elderly Waiver (EW) services.
- If you are billing with an NPI, you must include taxonomy in box 33a of a claim.
- If you are billing with an UMPI, no taxonomy is included in box 33b of a claim.
- Enter “Pass-through” within the notes section of a claim. UCare is required to identify which claims are pass-through for DHS.