Minnesota Insurance Changes for 2023

Important changes

Update 8/25/2023

UCARE UPGRADE PROGRAMS: For UCare Connect Plus Medicare and the Minnesota Senior Health Options plans in 2023, UCARE changed the benefit period for their extended benefits to 1 pair per year, a chage from 1 pair every 2 years in 2022. We’re learning now that this means that this benefit can ONLY be used once per CALENDAR year for members. For this program year, benefits started January 1st 2023 and will end December 31st 2023. The benefit will reset on January 1st 2024 if the program is continued. This means that RX changes, restyles, lost or broken pairs, or other patient or ECP remakes may not be fully covered with these plans. If an order is submitted for patients who have already used this benefit this year, customer service will be calling to let ECPs know and the orders will need to be changed.

Progressives will only be covered 1-time. If a patient has a qualified remake for power or other changes, a single vision or lined multi-focal will be required. There is no benefit exception for this. Patients cannot pay the difference between a standard job and the progressive. They may upgrade, but they must pay for the entire order, including the frame. These will be billed to the ECP at savings package package pricing.
Tints are only covered one time, however UCARE will accept tints needed for qualified medical necessity. Medically necessary tints must be submitted with a valid diagnostic code. Patients can also purchase tints as an add on (not an upgrade). Purchased tints will be billed to the ECP.
Photochromics are covered 1-time, however UCARE will accept photochromics needed for qualified medical necessity. Medically necessary photochromics must be submitted with a valid diagnostic code. Photochromic lenses are upgrades and not add-ons, so patients may not purchase photochromics separately. If a patient wants to purchase photochromics, they must pay for the entire order, including the frame. These will be bill to the ECP under savings package pricing.
Anti-Reflective coating will only be covered one time. There are no benefit exceptions for medical necessity with AR. Patients may purchase AR from the ECP as an add-on service, and these will be billed directly to the ECP.

For questions regarding Ucare’s extended benefits for these two plans, please contact Ucare Provider Servcies at 1-888-531-1493.

Each year we like to summarize any significant changes we’ve found in the managed care programs we service in Minnesota so our customers can prepare for the new year. Here are a few notes we’ve collected as 2022 ends on what to expect in the new year. We encourage providers to contact their contracted plans regarding their dispensing or exam contracts. Eye-Kraft does not have vendor relationships with plans not listed below, we’re unable to provide benefit or administrative information on any other plans. These notes may not be all inclusive of changes, and this information is subject to change, so review any communications from your accepted plans to prevent surprises. Thank you!

Maps:

The following are the maps of health plan service areas by county located on the Minnesota Department Of Human Services site. Maps are effective from Jan 1 2023 to Dec 31 2023.

Medica:

MEDICA PROVIDER SERVICES – 1-800-458-5512

Eye-Kraft Processes claims directly to Medica for the following plans:

Prepaid Medical Assistance Program (PMAP)
MinnesotaCare
Special Needs Basic Care with Medicare Medica Accessibility Solution® Enhanced
Minnesota Senior Health Options (MSHO)Medica DUAL Solution
Minnesota Senior Care Plus (MSC+) Medica Choice Care℠ MSC+

MEDICA – NEW FOR 2023

An additional 18 counties have been added to the Pre-Paid Medical Assistance and MN CARE plans.

Becker, Chisago, Clay, Crow Wing, Hennepin, Kittson, Mahnomen, Marshall, Norman, Otter Tail, Pennington, Polk, Red Lake, Roseau, Sherburne, St. Louis, Wadena, Wilkin, and Wright.

This is a Prepaid Medical Assistance program exclusive to Medica, so checking eligibility for these patients is easiest on the Medica Portal at www.medica.com. Call Medica Provider Services at 1-800-458-5512 to register.
Please note, the New Payer ID for these two plans are MEDMI
Group numbers start with the letter “A” for this plan.
This plan is basic coverage with frames and lenses.
Dispensing providers should verify registration for these plans with their clearinghouses. If you are not registered for these two plans all electronic dispensing claims will be denied.
If unregistered, paper claims for exams and dispensing can be submitted to: Medica Government Programs, PO BOX 21342, Eagan MN 55121-0342.
Eye-Kraft cannot register dispensing providers for this portal.

An Additional 14 counties have been added to the special needs basic care with Medicare Medica Accessibility Solution Enhanced Plan

Anoka, Becker, Carver, Chisago, Crow Wing, Dakota, Fillmore, Freeborn, Isanti, Hennepin, Kandiyohi, Kittson, Mahnomen, Morrison, Murray, Nicollet, Norman, Olmsted, Ramsey, Red Lake, Scott, Sherburne, Todd, Wadena, Washington, Wilkin, and Wright.

Additional 24 counties added to the Special Needs Basic care with Medica Accessibility Solution.

Aitkin, Anoka, Becker, Carlton, Carver, Chisago, Cook, Crow Wing, Dakota, Fillmore, Freeborn, Isanti, Hennepin, Kanabec, Kandiyohi, Kittson, Koochiching, Lake, LeSuer, Mahnomen, Mille Lacs, Morrison, Murray, Nicollet, Norman, Olmsted, Ramsey, Red Lake, Rice, Rock, Scott, Sherburne, St. Louis, Todd, Wadena, Washington, Wilkin, and Wright.

Medica will continue with their Anti-Reflective Coating benefit for members with groups #07xxx (Special Needs Basic Care Enhanced) & 08xxx (Minnesota Senior Health Option Plan).

Medica Links

UCare:

UCARE PROVIDER SERVICES – 1-888-531-1493

Eye-Kraft Processes claims directly to UCare for the following plans:

Minnesota Care
Minnesota Senior Care Plus
Minnesota Senior Health Options
Prepaid Medical Assistance Program
UCare Connect
UCare Connect Plus Medicare

UCARE – New for 2023

UCare Prepaid Medical Assistance Program (PMAP) and MinnesotaCare (MnCare) are in the following 44 counties:

Aitkin, Anoka, Benton, Blue Earth, Carlton, Carver, Cass, Chisago, Cook, Crow Wing, Dakota, Faribault, Fillmore, Freeborn, Hennepin, Houston, Isanti, Koochiching, Lake, Lake of the Woods, LeSuer, Matin, Mille Lacs, Morrison, Mower, Murray, Nicollet, Olmsted, Pennington, Pine, Ramsey, Rice, Rock, Roseau, Scott, Sherburne, St Louis, Stearns, Todd, Wadena, Washington, Watonwan, Winona, and Wright.

UCare Individual & Family Plans (IFP)

UCare will introduce two new plans in the 77-county Individual & Family Plan service area for 2023. The new plans are– IFP Bronze Access and IFP Gold Access.
Eye Kraft does not process these 2 plans.

UCare Provider Portal

UCare providers may access UCare’s Provider portal at https://www.ucare.org/providers (click log in)
Questions regarding the Provider Portal should be directed to UCare Provider Assistance Center at 1-888-531-1493
Eye-Kraft cannot assist with UCare Provider Portal access or questions

UCARE – Continued services for 2023

UCare will continue to cover anti-reflective coating, photochromic lenses, tints, and progressives on their UCare Connect Plus Medicare and the Minnesota Senior Health Options plan in 2023.

These are covered benefits – no prior authorization or diagnostic code is needed. This is at no cost to the member.
These services will only be processed for UCare through Eye-Kraft.
UCare covers this benefit 1 time per year (Note this has changed from 1 time every 2 years)
Progressives will be Eye-Kraft’s non-compensated free-form digital design. No upgrades or substitutions are allowed for the benefit.
Covered Anti-reflective coatings are Eye-Kraft’s ClearKraft2 or ClearKraft HEV. If patients are eligible for this benefit, Eye-Kraft will not bill providers for the treatment.
AR orders are complete frame and lens orders, we will not add AR to existing lenses.
Photochromic lenses will be lab choice based on Rx, availability, and lens design.
This benefit covers standard solid or gradient tints only. Therapeutic and specialty tints require medical necessity and diagnostic codes and are not covered under the MSHO and UCare Connect plans.
Either photochromic lenses or tints will be approved for the benefit but not on the same order. Providers do have the option of adding the tint to photochromic and clear lenses and billing the patient for it. Tinting over photochromic lenses does not void standard warranties.
Providers will continue to bill exam and dispensing fees as usual. Providers are allowed to bill the trifocal dispensing code for progressives. UCare will not be adding a progressive dispensing code.

Ucare Provider Portal Links

Admin Setup Guide
Admin User Guide
Request Admin Access
- IMPORTANT! Eye-Kraft cannot manage portal access at any level for providers. Providers must contact Ucare provider services directly to manage registration, access, and organizational users.
UCare Provider Manual
DHS Guidelines – Provider Manual for Optical Services

2023 UCare Plan Links

South Country Health Alliance:

SOUTH COUNTRY PROVIDER SERVICES – 1-888-633-4055

Eye-Kraft Processes claims directly to SCHA for the following plans:

Minnesota Care
Minnesota Senior Care Plus MSC+
Prepaid Medical Assistance Program
Minnesota Senior Health Options (MSHO)
Special Needs Basic Care (SNBC)

SCHA – New for 2023

SCHA is available in the following counties for 2023

Brown, Dodge, Goodhue, Kanabec, Sibley, Steele, Wabasha, and Waseca.

Note: SCHA will be closed every day from 12:00pm – 1:00 pm for lunch

No other changes for 2023

Links

Optical Services
Medicaid Programs
DHS Guidelines – Provider Manual for Optical Services