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Frequently Asked Questions regarding UCare ID card change in 2014 What is changing with UCare’s ID cards in 2014? UCare will no longer print the member’s primary care provider (“PCP”) on the member identification (ID) card for coverage effective January 1, 2014 and ongoing. The inset card image is intended to show where the PCP field was on previous cards. This field or line will not show on 2014 cards. The decision to remove the PCP field from member ID cards does not change the value UCare places on the primary care model. UCare will continue to encourage all members to have a regular doctor who they see routinely. Like today, members can receive care from any provider in our large provider network without a referral. Enrollment forms for Minnesota Health Care Programs (MHCP) and UCare for Seniors will continue to ask enrollees to select a primary care clinic (PCC), and all UCare members (except UCare Choices members) will continue to have a PCC designated to them in UCare’s claims payment platform. If the member does not select a clinic during the enrollment process, UCare will continue to “auto‐
assign” a PCC located in the same zip code as their home address. Why is UCare removing the PCP field from member ID cards? • The ultimate goal is to reduce member concern and confusion while avoiding the rework and cost associated with re‐issuing ID cards due to PCC changes. • Members are often assigned to a PCC that they are not going to for care. Many members, especially those in PMAP, MnCare and UCare Connect, often do not select a PCC when they enroll. When a PCC is not selected upon enrollment, UCare uses a process to select a PCC closest to the member’s address. This process or logic often assigns members to a clinic they do not use. • Members often call Customer Service to change their clinic when their ID card displays an inaccurate assignment. Members are sometimes confused or concerned that they won’t be able to get care if they do not go to the clinic listed on their card. • Today when a member changes their PCC, UCare sends them a new ID card. A number of resources are needed within UCare to support re‐issuing ID cards due to incorrect PCC assignments. How can members and/or providers know which PCC the member is assigned to with UCare? If members would like to know which PCC they are assigned to within UCare’s systems, they can call Customer Service. Providers can look up their patient’s PCC assignment on the Provider Portal by looking up the member in “Member Information”. Providers can also call the Provider Assistance Center to determine which PCC a patient is assigned to. Care coordinators can continue to review their monthly enrollment rosters to verify their clients’ PCC assignments. Will the PCP field be printed on UCare Choices ID cards? PCPs will not be printed on UCare Choices (MNsure) member cards. UCare Choices members will not be assigned to a PCC within UCare’s claim system. Can members go to a clinic even if it’s not printed on their ID card? Yes. Members can receive care from any provider in their plan’s network without a referral. They do not need to be assigned to a PCC in order to receive care at an in‐network PCC. How will this impact care coordination for MSHO, MSC+ and UCare Connect members? The change to the ID card will not impact or change how MSHO, MSC+ and UCare Connect members are assigned care coordination and/or care navigation. Care coordinators should continue to work with their clients and UCare to ensure they are assigned to the appropriate PCC. UCare will continue to accept and process PCC change requests as we did prior to the ID card change. How will Restricted Recipient Program members and their providers know which PCP they are restricted to? When a member is enrolled in the Restricted Recipient Program (see definition below), they receive a letter indicating which PCC, hospital and pharmacy they are restricted to. UCare ID cards do not include any indicators that a member is enrolled in the Restricted Recipient Program. Providers should look up patients in the state’s MN‐ITS system to determine eligibility and any program restrictions, including the providers the enrollee is restricted to. The Restricted Recipient Program identifies Minnesota Health Care Program members who have used services at a frequency or amount that is not medically necessary and/or who have used health services that result in unnecessary costs. Restricted Recipient Program participants are placed under the care of a designated primary care physician and other providers who coordinate and monitor their care. Can members change their PCC assignment? If so, how? Yes. If members are aware that UCare has assigned them to an incorrect PCC, they can log into the member site and select “Change Primary Care Clinic” under Account Services. Members can also call Customer Services to change their PCC. Some clinics and care coordinators work directly with their patients to submit PCC change requests. UCare will continue to process requests that come directly from clinics and care coordinators. Do we still need to notify members when a PCC closes? Yes. Our contracts with the Department of Human Services and federal rules require health plans to make a good faith effort to notify members in writing 15‐30 days before a participating provider terminates from the network. When a contract termination involves a primary care professional, all enrollees who are patients of that primary care professional are notified by letter and they are given alternative primary care clinic options to choose from.