Pharmacy
Please see the Pharmacy page for information regarding Medical Injectable Drug Authorizations.
*MultiPlan Providers should reference these Authorization Grids.
**Effective 5/12/2023 through 12/31/2023, pre-admission review for LTACH and AIR will not be required. Please submit notification of the admission within 24 hours of admission.
***Effective 06/12/2023 through 12/31/2023, pre-admission review for Children’s Residential Treatment for will not be required for UCare Individual and Family Plans. Please submit notification of the admission within 1 business day of the admission.
Pharmacy
Please see the Pharmacy page for information regarding Medical Injectable Drug Authorizations.
Authorization and notification forms and product-specific information.
Authorization and notification forms and product-specific information.
Authorization and notification forms, formulary and recall information.
The Behavioral Health Case Management Referral Form is completed when you have a UCare PMAP, MNCare, MSHO or MSC+ member who has a complex Behavioral Health condition.
The Care Management Referral form is completed when you have a member/patient who you feel would benefit from care coordination services and is actively enrolled in UCare Connect, UCare Connect + Medicare, PMAP (under 65), UCare Medicare Plans or Individual & Family Plans.
Care Management Referral Form - PDF
Care Management Referral Form - Word
The Complex Case Management Referral form is completed when you have a medically complex member/patient who you feel would benefit from short term / intensive medical case management. They typically have a new critical medical event, multiple medical diagnoses with challenges or high medical costs/utilization. This program is for UCare Medicare and Individual & Family Plans and PMAP/MNCare.
UCare works with delegated organizations to handle the following types of authorization.
Chiropractic Authorization:
Direct all authorization questions to UCare's delegate, Fulcrum Health, Inc. | 1-877-886-4941 (toll free)
Dental Authorization:
Direct all authorization questions to UCare's delegate, Delta Dental of Minnesota
Medical Injectable Drug Authorization:
Direct all authorization requests to UCare’s delegate: Care Continuum, a subsidiary of Express Scripts Online (ePA) at www.express-path.com/ | Phone: 1-800-818-6747 (toll free) | Fax: 1-877-266-1871
In order for services to be eligible for payment by UCare, the services must meet UCare’s standards for coverage, including medical necessity criteria. Coverage and benefits vary significantly among different UCare plans. Medical Necessity Criteria has been added to the Medical Authorization and Notification grids.