bulletin 2019 feb28 providermanualupdate


1 Feb. 28, 2019 UCare Provider Manual Has Been Updated contains critical information that providers need to effectively work with UCare and our UCare’s Provider Manual r egularly for up - to - date content. The members. It is important that providers reference has been it Provider Manual updated to reflect current business practices. at sed . Please review the entire Provider Manual while The Provider Manual can be acces www.ucare.org/providers paying close attention to the updated sections mentioned below. UCare’s Provider Assistance Center at 612 - 676 - 3300 or 1 - If you have any questions, contact - 531 - 1493. 888 Below is a summary of the key updates that were made in the UCare Provider Manual: The resource remains a PDF with a table of contents that links to specific sections. The date the docum  ent Appendix the was last updated is shown on the front cover. As the year progresses, will contain an update chart that briefly describes changes made and links to the updated sections. All chapters that reference UCare products have been  updated to include our new product (UCare Medicare with Fairview & North Memorial) and to reflect the new product names (UCare for Seniors is now called ; UCare Choices/Fairview UCare Choices UCare Medicare Plans UCare Individual & Family are now called Pl ans/UCare Individual & Family Plans with Fairview).  The Delegated Services chapter now has a section related to p hysician a dministered d rugs.  Sales & Marketing by Providers chapter , new information has been added to the Permitted Marketing In the s Activitie section. Several changes have been  d e to the Claims chapter , including updates regarding the C laims ma R econsideration Request Form, p aper c laims, provider appeals and void and replacement claims .  nterchange chapter, a section has been added on Electronic Data Submission (837) In the Electronic Data I Payor ID List.  The Authorizations and Notifications section has been updated to reflect UCare’s current practices. All UCare providers should review and be familiar with the content in this section.  The Medic al Necessity Guidelines section has been updated to reflect the suspension of Authorizations for UCare Individual & Family Plans/UCare Individual & Family Plans with Fairview members for 2019. Notifications are still required.

2 w and be familiar with the content in the Fraud, Waste and Abuse section.  Providers should revie The Health Promotions section has new information about UCare’s programs for the Dental Care Kit, UCare’s  Mobile Dental Clinic, Community Education Discount and UCare Member Perks .  The Behavioral Health chapter has been updated to reflect UCare’s current practices. Providers should review and be familiar with this chapter.  In the Hospital Services chapter, information has been added about observation admissions .

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