Pharmacy

Commercial products for individual and family (IFP) coverage available through MNsure, including UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview.

Medicare Programs

UCare Medicare Plans, UCare Medicare Plans with M Health Fairview and North Memorial, UCare Medicare Group Plans, UCare Advocate Plans, EssentiaCare and UCare Your Choice Plans.

Medicare + Medical Assistance

UCare Connect + Medicare and Minnesota Senior Health Options (MSHO)

State Medical Assistance Programs

UCare Connect (Special Needs BasicCare), Minnesota Senior Care Plus (MSC Plus), MinnesotaCare (MnCare), Prepaid Medical Assistance Program (PMAP)

Resources & Information

Electronic Prior Authorization (ePA)

ePA is the preferred method to submit Prior Authorization requests to Navitus for pharmacy benefit drugs. Providers may use ePA through Surescripts, CoverMyMeds or the Electronic Health Record.

For info on Medical Injectable Drug Prior Authorization requests, see "Medical Injectable Drug Prior Authorization Resources" on the Pharmacy page.

Medical Injectable Drug Prior Authorization Resources

See the Medical Injectable Drugs requiring prior authorization.

Participating providers can submit prior authorization, authorization adjustment and pre-determination requests to Care Continuum one of the following ways:

• Online (ePA) via the ExpressPAth Portal at www.express-path.com/. Providers can submit requests, check on the status of submitted requests, and submit an authorization renewal on the ExpressPAth Portal. The site also provides 24/7 access, potential for real-time approvals and email notifications once a decision is reached.
• Fax an authorization request form to Care Continuum at 1-877-266-1871.
• Call Care Continuum at 1-800-818-6747.

Non-participating and MultiPlan providers can submit prior authorization, authorization adjustment and pre-determination requests to UCare one of the following ways:

• Fax an authorization request form to UCare Clinical Pharmacy Intake at 612-617-3948.
• By mail to UCare, Attn: Pharmacy at P.O. Box 52, Minneapolis, MN 55440-0052.

Providers that receive a claim denial will continue to work through the provider claims appeal process using the Provider Claim Reconsideration Request Form.

Medication Therapy Management (MTM) Program

Our Medication Therapy Management (MTM) Program is a free service for eligible UCare members to optimize their medication therapy, experience and outcomes. Members receive a one-on-one consultation with a pharmacist to review their entire medication regimen (including prescription, over-the-counter medications and herbal supplements) to help resolve any potential medication-related problems regarding indication, effectiveness, safety and convenience.

UCare partners with many pharmacists across the state of Minnesota and provides reimbursement for MTM services for in-network pharmacist practitioners.

Please refer to the MTM section of the provider manual for full program information including detailed topics such as eligibility, expectations, audits, billing and more.

Eligibility

• Most UCare plans with prescription drug coverage are eligible for MTM services and can receive these services with contracted local pharmacists.
• Internal UCare telephonic MTM services are only available to Medicare, Connect + Medicare, MSHO and select Medicaid members.
  

Billing

UCare’s expectation is that MTM services will be billed using MTM CPT codes 99605, 99606 and 99607. Billing is based on complexity, not time, for all lines of business.

Program Information

Important Time Sensitive Requirement Reminders

• All Medicare members must be provided with CMS standardized format materials (including medication action plan and personalized medication list). These should be provided within 14 days of the encounter.
• UCare's Continuity of Care Document (CCD) must be submitted within 45 days of the original visit for Medicare members.
• Member opt-outs from the MTM program must be received within 30 days of member’s decision to opt-out.

Continuity of Care Document (CCD)

MTM providers are required to maintain and submit a CCD for all Medicare visits. It is acceptable to send information for non-Medicare members as well.

Questions

For any questions or inquiries regarding the MTM program at UCare, please contact us via email at pharmacyliaison@ucare.org.

Additional Helpful Resources

• Medication Therapy Management | Centers for Medicare & Medicaid Services
• MHCP Provider Manual - Medication Therapy Management Services (MTMS)