Memo Template

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Memo
To:
County Partners
From: UCare County Staff
Date:
Thursday, October 3, 2013
Re:
Update on 27-county PMAP/MnCare reprocurement RFP
Dear County colleagues,
As a result of the recent 27-county PMAP/MinnesotaCare reprocurement RFP, we expect that
UCare will be either the only health plan choice (Aitkin, Cook, Kittson, Koochiching, Lake,
Marshall, Mower, Norman, Pennington, Pine, Red Lake, Roseau, Winona), one of two health
plan choices (Benton, Carlton, Chisago, Fillmore, Houston, Isanti, Mille Lacs, Olmsted, Polk,
St. Louis, Sherburne, Stearns), or a new health plan in two counties (Lake of the Woods,
Mahnomen). We know the letters sent from Minnesota Department of Human Services to
impacted members have raised some questions so here is some quick reference information
that will be helpful to county staff in responding to inquiries.
We will communicate further information in the future but wanted to get these key points to
you now. We will be contacting counties to set up our annual face-to-face meetings and can
meet again with those we already visited this year, if that is of interest. As always, please
contact the County Hotline for help with any other information you need at 1-866-457-7146.
Key Points
Member Services
• UCare is ready to handle the increase in volume of calls from members.
• All new members receive a welcome call from UCare.
Network Access
• We are currently evaluating our primary care clinic network, especially in the
counties where UCare will be the only health plan choice. UCare plans to fill in
identified gaps where the UCare network needs to expand.
• UCare has a comprehensive hospital and specialty network.
• If you have questions about particular providers in our network, use the Find a
Doctor tool or contact the County Hotline noted above.
Behavioral Health Network
• UCare will be working with a NCQA accredited partner to manage mental health
and chemical dependency services effective 11/1/13 (new contact number: 1-888531-1493). They will be co-located at UCare to enhance our ability to work
together across UCare’s behavioral health, pharmacy, and medical management
teams to address the needs of our members requiring those services.
• We expect transition of mental health services to be seamless for enrollees
switching health plans. For more information, access the full provider notice
about this transition.
• UCare recognizes the expertise counties bring to the determination of eligibility
for Mental Health Targeted Case Management and Assertive Community
Treatment services. Effective 11/1/13, we will accept the county determination
of eligibility and no longer require notification or authorization of these
services.
Dental Network
• UCare contracts with DentaQuest for delivery of a dental network to its members.
• DentaQuest maintains an extensive network of dentists. They are in the process of
evaluating their provider network against the UCare expansion area to ensure
adequate access for new members.
• The “Clinical Transitions” section below is applicable to dental services.
• UCare members can call DentaQuest’s unique See-A-Dentist Guarantee
Appointment Hotline at 1-800-235-0564 to receive assistance with making a
dental appointment.
• Our mobile dental clinic may have additional capacity. View the mobile dental
clinic schedule. Call 1-866-451-1555 toll free for appointments.
Pharmacy
• We will communicate to both members and physicians on processes to request
continued coverage for transitional medications.
Transportation
• To schedule transportation services, eligible members may call Health Ride at
1-800-864-2157, available 24 hours a day, seven days a week.
• Our network can accommodate additional members.
Health Promotion
• UCare has member incentives for several preventive health measures. For
instance, rewards and incentives focused on helping children receive their
preventive health C&TC visits.
• For more information, see UCare’s Health Promotion programs and download
incentive coupons.
Clinical Transitions
• Continuity of care, out-of-network and transition service policy:
UCare honors authorizations from other plans and permits out-of-network
providers as needed to ensure continuity of care.
Provider Relations & Contracting
• Information on working with UCare as a provider is found on the UCare Provider
web page.
• For billing questions providers can contact the Provider Assistance Center (PAC)
at 1-888-531-1493.
County Resources
• If you are not sure who to call, contact the County Hotline 1-866-457-7146 for
assistance.
• County Support:
o UCare website – county information
o County News Briefs quarterly newsletter – recent issue
o In-person meetings, conference calls, and trainings
Thank you for your partnership in serving UCare members,
Carol Berg, BSN, MPH
County and Public Health Manager | Government Relations | UCare
Phone: 612-676-3635 Fax: 612-676-6501 Email: [email protected]
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