Care Coordination Resources
UCare Connect + Medicare
To find product-specific tools and forms, select the desired plan from the "Please select" drop-down and click "Select Plan" to explore each category and its contents.
Connect Requirements Grid (Revised 1/1/2024)
MnCHOICES Connect Requirement Grid (Revised 1/1/2024)
Change of Care Coordination Letter (Revised 8/26/2022)
Connect/Connect + Medicare CC Appointment Letter (New 5/30/2023)
Health Resource Letter (Revised 2/28/2023)
PCP/ICT Support Plan Cover Letter (Revised 1/1/2024)
PCP/ICT Support Plan Fax Cover Sheet (Revised 1/1/2024)
Provider Engagement Letter (Revised 7/6/2022)
Refusal Letter (New 1/5/2022)
Support Plan Letter (Revised 8/31/2022)
Support Plan Signature Letter (Revised 8/31/2022)
Unable to Reach Member Letter (Updated 9/8/2022)
Unable to Reach Member Letter - Hmong (New 1/1/2024)
Unable to Reach Member Letter - Somali (New 1/1/2024)
Unable to Reach Member Letter - Spanish (New 1/1/2024)
Welcome Letter (Revised 8/2/2022)
Welcome Letter (Waiver) (New 8/2/2022)
2023 Monthly Activity Log (Revised 8/29/2023)
2024 Monthly Activity Log (Revised 1/30/2024)
Death Notification Form
Primary Care Clinic Change Request
Refusal Support Plan - PDF (Revised 1/1/2024)
Refusal Support Plan - Word (Revised 1/1/2024)
Release of Information Form (New 1/1/2022)
Support Plan Signature Sheet - MnCHOICES (New 10/2/2023)
Support Plan Member Signature Page (New 5/15/2023)
Support Plan - PDF (Revised 4/26/2023)
Support Plan - Word (Revised 4/17/2023)
Transfer Member Heath Risk Assessment - PDF (Revised 10/31/2023)
Transfer Member Heath Risk Assessment - Word (Revised 10/31/2023)
UTR Support Plan - PDF (Revised 1/1/2024)
UTR Support Plan - Word (Revised 1/1/2024)
Transition of Care Log (Revised 12/30/2022)
TOC Log Instructions (Revised 12/27/2022)
Transition of Care (TOC) Notification to PCP
Transition of Care Talking Points