Updated Prior Authorization Criteria for Drugs on the UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview Plans Formulary

On March 1, 2024, UCare will update prior authorization criteria for two drugs or categories that are on the UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview formulary.

See the February 8 Provider Bulletin for details.

February 2024 Health Lines

Learn about the following: Reminder: Trainings available for Minnesota Provider Screening and Enrollment Portal (MPSE), Reminder: UCare 2024 pharmacy benefit information, Interactive Voice Response (IVR) or texting program - asthma and diabetes, Human papillomavirus (HPV) vaccination and cervical cancer screening, Fall prevention, Fraud, waste and abuse reporting reminder and How to access the UCare for providers webpage. 

Read the February 2024 Health Lines.

Importance of maintaining accurate provider data

Providers are required to make sure UCare has current demographic information on their practice, available practitioners and services offered. Regularly reviewing and updating this information ensures that UCare members are using the latest data, allowing them to access care more easily.

See the February 2 Provider Bulletin for details. 

Early Intensive Development and Behavioral Intervention (EIDBI) Claims Payment Reminder

In December 2023, the Minnesota Department of Human Services (DHS) updated EIDBI billing guidelines clarifying information regarding Comprehensive Multi-Disciplinary Evaluations (CMDE). Per the update, CMDE providers are not required to be affiliated with an EIDBI agency and do not require a Qualified Supervising Professional (QSP) to be listed on claims.

See the Jan. 4 Provider Bulletin for details. 

MinnesotaCare Tax is Changing Jan. 1, 2024

Effective Jan. 1, 2024, the amount of the tax imposed on health care providers under Minn. Stat. § 295.52 (known as the “MinnesotaCare Tax”) is changing from 1.6% to 1.8% of gross revenues. As a result, the portion of provider reimbursement that represents payment by UCare for providers’ MinnesotaCare Tax expense will be adjusted accordingly, as applicable, effective for dates of service beginning Jan. 1, 2024.

Read the Dec. 20 Provider Bulletin for details. 

2024 Code and Editing Updates

New codes have been identified for 2024 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.

See the Dec, 1 Provider Bulletin for details.

UCare to Implement Outpatient Hospital Pricing Software and Select Inpatient Post-Payment Claims Review

UCare issues a Provider Bulletin regarding two new claim implementations. For details, please review the November 16 Provider Bulletin.

UCare to Implement Six Month Timely Filing of Claims for Minnesota Health Care Programs (MHCP) Products

The Minnesota Department of Human Services is requiring managed care organizations to immediately implement a new timely filing requirement, due to a statute change passed by the Minnesota Legislature earlier this year. As a result, UCare has updated its timely filing requirements from 12 months to six months, effective Aug. 1, 2023, for MHCP products.

See the November 14 Provider Bulletin for details.

UCare's 2024 Authorization & Notification Grids

The UCare 2024 authorization and notification requirements are now available.

For a list of changes, please see the November 13 Provider Bulletin. 

View the 2024 authorization grids on the Authorizations page.

UCare Selects Navitus Health Solutions as New Pharmacy Benefit Manager for 2024

Beginning Jan. 1, 2024, UCare will transition to a new Pharmacy Benefit Manager, Navitus Health Solutions. Navitus will process pharmacy claims, perform first-level prior authorization reviews, manage the pharmacy network and manage the Pharmacy Help Desk for all UCare plans.

See the November 10 Provider Bulletin for details. 

Pharmacy Formulary and Benefit Changes for 2024

UCare shares its 2024 pharmacy formulary and updates, a reminder about Medicare Part D vaccine coverage and how it is notifying impacted members and providers of changes.

See the November 10 Provider Bulletin for details. 

Medical Drug Prior Authorization for 2024 and Preferred Product Step Therapy Information

Care Continuum will continue to perform authorization reviews for participating providers for all lines of business in 2024. Non-participating and MultiPlan providers will submit prior authorizations directly to UCare using an updated authorization request form.

See the November 10 Provider Bulletin for details. 

UCare Individual and Family Plans 2024 Plan Year Benefit Expansion: Doula Services

Starting Jan. 1, 2024, UCare will add coverage for doula services to UCare Individual & Family Plans (IFP) and UCare Individual & Family Plans with M Health Fairview. UCare strives to support the best birth and infant health outcomes to improve health equity.

See the October 2 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 5 Provider Bulletin for details.