UCare Prior Authorization Lookup
Latest UCare prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Authorization and Notification RequirementsDefines UCare prior authorization and notification requirements for a range of inpatient, outpatient, procedural, durable medical equipment, behavioral health, and cosmetic services for listed Minnesota plans and affected providers.All UCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Authorization and Notification Requirements - Effective January 1, 2026Lists services that require prior authorization or notification for UCare plans serving Minnesota populations and explains submission and timing expectations for providers.All UCare updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Authorization and Notification Requirements - Effective January 1, 2026Governance of prior authorization and notification rules for inpatient and outpatient services across UCare plans (including MinnesotaCare, MSC+, PMAP, UCare Connect, and IFP). Affects enrolled providers submitting requests for authorization or notifications to UCare.All UCare updates
- Prior AuthClinical/Medical PolicyEff. 2025-06-01Authorization and Notification RequirementsGoverns prior authorization and notification requirements for inpatient and outpatient services for UCare's Minnesota Senior Health Options (MSHO) and UCare Connect + Medicare plans; affects network providers submitting requests to UCare.All UCare updates
- Prior AuthClinical/Medical PolicyEff. 2025-06-01Authorization and Notification Requirements (UCare Medicare Plans)Defines prior authorization and notification requirements for inpatient and outpatient services for UCare Medicare plans, including provider obligations, timelines, and lists of services and codes that require authorization or notification.All UCare updates
- Prior AuthClinical/Medical PolicyEff. 2025-06-01Authorization and Notification Requirements - UCare Individual & Family Plans (IFP)Defines UCare prior authorization and notification requirements for inpatient, outpatient, DME, procedures, genetic testing, and other services for UCare Individual & Family Plans (IFP) and IFP with M Health Fairview. Affects providers submitting requests for covered members under these plans.All UCare updates
- Prior AuthAdministrative/Operational PolicyEff. 2025-01-01Prior authorization and notification requirements for UCare plansThis document lists services that require prior authorization or notification across specified UCare commercial, Medicare, and Medicaid plans and describes auxiliary aids contact information. It affects providers and delegated entities submitting authorizations for members of the listed UCare products.All UCare updates
- Prior AuthClinical/Medical PolicyEff. 2025-01-01Services Requiring Prior Authorization or NotificationLists medical services and items that require prior authorization or notification for specified UCare health plans in Minnesota; affects providers and facilities submitting authorization requests for members of those plans.All UCare updates
- Prior AuthAdministrative/Operational PolicyEff. 2025-01-01UCare prior authorization and notification requirementsThis document lists services that require prior authorization or notification for specified UCare lines of business (Medicare, Medicaid, and individual products) and indicates which product lines each service applies to.All UCare updates
- Prior AuthAdministrative/Operational PolicyEff. 2025-01-01UCare prior authorization and notification requirements (2025)Lists services that require prior authorization or notification for various UCare health plan lines (Medicare, Medicaid, Individual & Family) and which services are excluded because delegated organizations handle them. Affects providers and delegated organizations contracting with UCare in Minnesota.All UCare updates
- Prior AuthClinical/Medical PolicyEff. 2024-04-01Reconstructive and Cosmetic Health ServicesDefines medical necessity criteria, examples of reconstructive services that are covered, and examples of cosmetic services that are not medically necessary for UCare members; applies to providers submitting coverage requests and prior authorizations in Minnesota and other UCare plans as described.All UCare updates
- Prior AuthClinical/Medical PolicyEff. 2024-03-15Adzynma (recombinant ADAMTS13) — coverage criteria for congenital TTPDefines prior authorization, coverage criteria, dosing, and documentation requirements for Adzynma (recombinant ADAMTS13) used as prophylactic or on‑demand enzyme replacement in congenital thrombotic thrombocytopenic purpura for adult and pediatric patients.All UCare updates
- Prior AuthClinical/Medical PolicyEff. 2023-11-15Adstiladrin (nadofaragene firadenovec) — Utilization Management / Coverage CriteriaDefines utilization management, prior authorization, and coverage criteria for Adstiladrin for adults with high‑risk BCG‑unresponsive non‑muscle invasive bladder cancer (CIS with or without papillary tumors or Ta/T1 papillary tumors without CIS) across all UCare plans.All UCare updates
- Prior AuthClinical/Medical PolicyEff. 2023-11-15Oncology (Intravesical) - Adstiladrin UM Medical PolicyDefines prior authorization and medical necessity criteria for coverage of Adstiladrin in adults with BCG-unresponsive non-muscle invasive bladder cancer (NMIBC); applies to all UCare plans.All UCare updates
- Prior AuthClinical/Medical PolicyEff. 2023-01-01Medical Benefit Drug Prior Authorization ProgramDefines UCare's 2023 medical benefit drug prior authorization requirements, workflows, and biosimilar step therapy preferences for providers submitting PA requests across all lines of business.All UCare updates
- Prior AuthClinical/Medical PolicyEff. 2022-01-01Oncology (Injectable - Microtubule Inhibitor) - Paclitaxel Albumin-Bound Products Utilization Management Medical PolicyDefines prior authorization, coverage criteria, and dosing for paclitaxel albumin-bound (Abraxane) for UCare Medical Assistance and Exchange plans; applies to oncologists and providers prescribing this agent for adult cancer indications.All UCare updates
- Prior AuthClinical/Medical PolicyEff. 2021-07-01Abecma (idecabtagene vicleucel) — Medical-benefit prior authorization and coverage criteriaDefines medical-benefit prior authorization and coverage criteria for Abecma (idecabtagene vicleucel) for UCare Medical Assistance and Exchange Plans, applicable to adults with relapsed or refractory multiple myeloma after prior therapies.All UCare updates
- Prior AuthClinical/Medical PolicyEff. 2020-05-01Sickle Cell Disease - Adakveo Utilization Management Medical PolicyThis policy governs prior authorization and medical benefit coverage criteria for Adakveo (crizanlizumab-tmca) to reduce vasoocclusive crises in patients with sickle cell disease age ≥16 across all UCare plans.All UCare updates
- Prior AuthClinical/Medical PolicyEff. 2020-01-01Adcetris (brentuximab) utilization and coverage criteriaDefines prior authorization, coverage criteria, dosing limits, and approved indications for Adcetris (brentuximab) for UCare plans; applies to providers prescribing or administering the drug.All UCare updates
- Prior AuthClinical/Medical PolicyEff. 2020-01-01Enzyme Replacement Therapy - Aldurazyme (laronidase) Utilization Management Medical PolicyDefines prior authorization and coverage criteria for Aldurazyme (laronidase IV) for treatment of mucopolysaccharidosis type I (MPS I) across all UCare plans, including diagnostic requirements, prescriber specialty, dosing limits, and approval duration.All UCare updates
- Prior AuthClinical/Medical PolicyEff. 2020-01-01Inflammatory Conditions - Tocilizumab Intravenous Products Utilization Management Medical PolicyThis policy governs prior authorization and coverage criteria for intravenous tocilizumab products (Actemra, Avtozma, Tofidence) for UCare Medical Assistance and Exchange Plans. It outlines indications, dosing, step therapy (preferred product Tyenne), and authorization durations for approved indications.All UCare updates
- Prior AuthClinical/Medical PolicyEff. 2020-01-01Inflammatory Conditions - Tocilizumab Intravenous Products Utilization Management Medical PolicyPrior authorization and utilization management criteria for medical-benefit tocilizumab intravenous products for UCare Medical Assistance and Exchange plans (PMAP, Connect, MSC+, MnCare, Individual and Family Plans). Includes FDA-approved indications, other supported uses, dosing thresholds, step therapy (preferred product) and conditions not recommended for approval.All UCare updates
- Prior AuthClinical/Medical PolicyEff. 2020-01-01Inflammatory Conditions - Tocilizumab Intravenous Products Utilization Management Medical PolicyDefines prior authorization, step-therapy, and medical necessity criteria for intravenous tocilizumab products (Actemra, Avtozma, Tofidence) for UCare medical plans; excludes acute inpatient COVID-19 treatment. Affects prescribers, prior auth reviewers, and plan members.All UCare updates
- Prior AuthClinical/Medical PolicyEff. 2020-01-01Oncology (Injectable) - Aliqopa Utilization Management Medical PolicyDefines prior authorization criteria, coverage conditions, dosing limits, and prescribing requirements for Aliqopa (copanlisib) for UCare plans, with specifics for follicular lymphoma and marginal zone lymphoma and guidance for patients currently receiving therapy.All UCare updates
- Prior AuthClinical/Medical PolicyEff. 2020-01-01Repository Corticotropin (Acthar Gel) Utilization ManagementDefines prior authorization, coverage criteria, dosing, and conditions for approval or non-coverage of Acthar Gel for UCare members; applies to prescribers requesting pharmacy benefit coverage of repository corticotropin (Acthar Gel).All UCare updates
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Tool Description
Search UCareprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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Prior auth requirements change all the time. Keep up with every payer policy update in the live policy feed, or browse payers with prior authorization policies.
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