1

Early Intensive Developmental and Behavioral Intervention (EIDBI) Managed Care Organization (MCO) Contact Information Grid

Category of Blue Cross Blue Hennepin Medica Prime West South Country UCare United Healthcare
HealthPartners IMCare
Information Shield of Health Health Health Alliance
Minnesota
Member Services:
Member Contact
Center
866-431-0801
Member Services: Member Services:
Member Services: Providers:
952-967-7998 612-676-3200 or
612-596-1036 or Provider Contact
Member Services: 800-203-7225
Main phone 800-647-0550, Center
800-711-9862 Toll free: Member Services: Member Services:
option 1 866-431-0802
number for TTY: 711 866-885-8880 Member Services: Member or 866-567-7242 Provider Services: 888-269-5410
Both the Member
Patient or Family TTY: 711
Provider
218-327-6188 or Provider Services:
Contact Center and
612-676-3300 or
and Providers: Provider Services: 800-843-9536 800-848-8327 Provider Services: 888-531-1493 (includes Provider Services:
Services: Provider Contact
Benefits 866-518-8448 Providers may use the 888-633-4055 specific option for 877-440-9946
612-596-1036 or Center phones are
provider portal webpage Mental Health and
800-647-0550, answered by live
healthpartners.com/provi Substance Use
option 2 staff. Calls can be
der-public/ Disorder providers)
transferred directly to
the appropriate
subject matter expert
if additional
assistance is needed.
Member Services:
Member Contact
Center
866-431-0801
Member Member Services: Providers:
Services: 612-596-1036 or Provider Contact
952-967-7998 Member Services:
Main phone Member Services: 800-647-0550, Center
Member Services: 612-676-3200 or
800-711-9862 option 1 866-431-0802 Member Services:
number for Toll free: Member Services: Member or 866-567-7242 800-203-7225
TTY: 711 Both the Member 888-269-5410
Patient or Family 866-885-8880
Provider
218-327-6188 or Provider Services:
Contact Center and
and Providers: TTY: 711 800-843-9536 800-848-8327 Provider Services: Provider Services:
Provider Services: Services: Provider Contact Provider Services:
Claims 888-633-4055 612-676-3300 or
866-518-8448 612-596-1036 or Center phones are 877-440-9946
Providers: 888-531-1493
800-647-0550, answered by live
952-883-7699 or 888-
option 2 staff. Calls can be
663-6464
transferred directly to
the appropriate
subject matter expert
if additional
assistance is needed.
January 2024
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Category of Blue Cross Blue Hennepin Medica Prime West South Country UCare United Healthcare
HealthPartners IMCare
Information Shield of Health Health Health Alliance
Minnesota
Member Services: Member Services:
612-596-1036 or Member Services:
800-711-9862
800-647-0550, 866-431-0801
TTY: 711
option 1 Online provider
Mental Health and
search tool: Member Services:
You can also Provider Services: Substance Use
PrimeWest Health 866-567-7242
952-883-5811 Provider Member Services: Member or Disorder Triage: 612-
For help finding a reference the online 218-327-6188 or Provider Search Tool Find A Provider – Member Services:
provider search tool Services: Provider Services: 676-6533 or 833-276-
provider: located at Toll free: 612-596-1036 or 800-843-9536 800-848-8327
South Country
1185 (TTY 800-688-
888-269-5410
A full directory can be Health Alliance
bluecrossmn.com/sh 888-638-8787 800-647-0550, 2535)
found under each (mnscha.org)
op-plans/minnesota- option 2 UCare’s find a provider
specific program at:
health-care-
primewest.org/progra
programs/public- Hennepinhealth.or ms
programs-find-doctor g

Member Services: Member Options available to

Provide A Ride:
952-967-7998 select language when
Member Services: Services: Member Services: Sets up interpreter Member Services:
Interpreter Member Services: Member Services: members call Member
800-711-9862 612-596-1036 or 218-327-6188 or services for 888-269-5410
services Toll free: 866-431-0801 866-567-7242 Services:
TTY: 711 800-647-0550, 800-843-9536 appointments: 952-
866-885-8880 612-676-3200 or
option 1 992-2292
TTY: 711 800-203-7225

Member Services: TTY/TDD:

National Relay
952-967-7998 711 or 800-627- TTY: 612-676-6810
Member Services: Center:
TTY services 3529 or 877-627- TTY: 800-627-3529 TTY: 800-627-3529, TTY: 711 (toll free)
800-711-9862 711 and dial Medica TTY: 711 (toll free)
(text telephone) TTY: 711
Toll free: 3848 (speech-to- or 711 (toll free)
Behavioral Health:
or 711 (toll free) 800-627-3529 Toll Free: 800-688-
866-885-8880 speech relay 2534
866-567-0550
TTY: 711 service)
Electronic
Authorization
Submission
Mental Health and
Provider Web
BH UM Department Substance Use
Medical/Behavior Portal:
Fax: Disorder Services
Fax number or primewest.org/forms/
952-853-8830 al Fax: 218-327-5545
Medica Behavioral authorization Online Portal:
mechanism for Providers may also use Health Prior Fax: Fax: 612-884-2033 or
Fax: 800-505-1193 Health Prior Authorization and
electronic the provider portal Authorization Secure email:
Fax: 855-454-8155 If unable to submit
888-633-4052 855-260-9710
Notification
submission webpage Fax: 612-677-6222 pwserviceauth@prime the request through
healthpartners.com/provi west.org Secure email:
the Provider Web
der-public/ MHSUDservices@ucar
Portal, the following
e.org
options are also
available:
Fax: 866-431-0804
January 2024
 3

Category of Blue Cross Blue Hennepin Medica Prime West South Country UCare United Healthcare
HealthPartners IMCare
Information Shield of Health Health Health Alliance
Minnesota

Secure email:
pwserviceauth@prim
ewest.org

Provider Services:
866-431-0802
Leadership
Contracting and Provider
personnel Live Provider Provider Services:
Provider Services: Provider Relations: Services: Peggy Rosik Michelle Schultz
to contact Contact Center staff 612-676-3300 or Provider Services:
800-262-0820 952-883-5589 or 612-596-1036 or 218-327-6199 877-887-2393, ext. Provider Services:
for 866-518-8448 888-638-6648 615205
can transfer your call
888-633-4055
888-531-1493 (issues 877-440-9946
800-647-0550, to the appropriate escalated as needed)
handling option 2
issues subject matter expert
if you require
additional support
Provider Relations: Provider
952-883-5589 or 888- Services:
612-596-1036 or Provider Services: Provider Services:
638-6648 Provider Relations:
Contracting for 800-647-0550, 866-431-0802 507-444-7770, To enroll with UHC as
Fax: 952-853-8848 Provider Services: 877-614-0484
Provider Services: option 3 Apply online at: a provider:
network 800-262-0820
option 2 218-327-6188 or 800- Lisa Marx
Email: or email: ucare.org/providers UnitedHealthcare
participation Submit an inquiry to 843-9536 Lisa.marx@optum.c
contracting@primew providerinfo@mnsc
contracting and payer Apply online at: om
est.org ha.org
relations HennepinHealth.or
g
All services require No referral
prior authorization for No referral requirements
out-of-network required. Some No referral
providers. No referral required services require Notification and requirements
No referral is authorization required
for in-network or out- authorizations.
required for the BH UM Dept.: Provider Services: of-network providers For additional No referral required for EIDBI services. Notification and
Referral service. 952-883-7501 No referral
218-327-6188 or 800- who are CMDE or questions, please for in or out of authorization required
requirements requirements
843-9536 EIDBI certified. contact: network providers Mental Health and for EIDBI services.
Services do require
Toll free: Services do require Member Services: Substance Use
authorization
866-669-3856 authorization. 866-431-0801 Disorder Services: Provider Services:
Provider Services: 612-676-6533 or 833- 877-440-9946
Fax: 866-431-0802 276-1185 toll free
952-853-8830

January 2024
 4

Category of Blue Cross Blue Hennepin Medica Prime West South Country UCare United Healthcare
HealthPartners IMCare
Information Shield of Health Health Health Alliance
Minnesota
Prior authorization
is required for
EIDBI services, as
follows:

Intervention –
Individual:
Adaptive Behavior
(97153UB)
Select services require
Intervention – notification or
Group: Adaptive authorization prior to
Behavior Some services
No authorization starting services.
Authorization needed (97154UB) require
required for Select services require
for: authorization. EIDBI
• Intervention CMDE*, Initial ITP notification or Use the Prior
– EIDBI – - PrimeWest Health
– Higher and Coordinated authorization prior to Authorization &
Individual/group
Intensity: Care Conference. Provider Services: starting services. Notification Tool to
– Family/Caregiver
Adaptive All other services Call: 888-633-4055 check prior
Training
Behavior including ongoing Online: Provider authorization
Prior and Counseling Provider Contact UCare’s MH & SUD
(0373T) ITP must be Portal and requirements, submit
– Individual/group Member Services: Center: Health Authorization
Authorization • Intervention submitted for Authorizations – new medical prior
Provider Services: – Observation and 218-327-6188 or 866-431-0802 &
requirements: 866-518-8448 Direction
–
800-843-9536
authorization of
primewest.org/web/g
South Country authorizations and
Individual: treatment services. Notification
Contracted Health Alliance inpatient admissions
uest/out-of-network- Requirements grid
Providers Observatio (mnscha.org) notifications, check the
healthpartners.com/publ providers details when a
n and *While status of a request,
ic/coverage-criteria
Direction authorization is not Notification required notification and/or and submit case
Electronic
(97155UB) required, we do for claims payment authorization is updates such as
BH UM Department: Authorization required
• Family or request that you uploading required
952-883-7501 Submission:
Caregiver fax CMDE * clinical documentation.
Toll free: 866-669-3856 primewest.org/forms/ ucare.org/providers
Training
Fax: 952-853-8830 authorization
and Fax: 855-454-8155 Prior Authorization &
Counseling Notification Tool:
– Individual Prior Authorization and
(97156UB) Notification
• Family or
Caregiver
Training
and
Counseling
– Group
(97157UB)
• Travel Time
(H0046UB)
January 2024
 5

Category of Blue Cross Blue Hennepin Medica Prime West South Country UCare United Healthcare
HealthPartners IMCare
Information Shield of Health Health Health Alliance
Minnesota

Fax prior
authorization
requests to
Hennepin Health
at 612-677-6222.

Refer to Hennepin
Health’s website
for more
information about
prior authorization
requirements:
HennepinHealth.or
g

Prior authorization
is required for Some services
EIDBI services, as require
follows: No authorization authorization. EIDBI
required for - PrimeWest Health
• Intervention CMDE*, Initial ITP
– Provider Contact
and Coordinated
Individual: Center:
Care Conference.
Adaptive 866-431-0802
All other services
Behavior primewest.org/web/g All services require
including ongoing
Prior All services require uest/out-of-network- authorization, please
(97153UB) ITP must be
Authorization authorization providers submit request using
• Intervention Member Services: submitted for Prior authorization
Provider Services: BH UM Department: Provider Services: the Prior Authorization
requirements: 866-518-8448 952-883-7501
– Group: 218-327-6188 or authorization of
888-633-4055
required before
& Notification Tool:
Electronic starting services
Noncontracted Adaptive 800-843-9536 treatment services.
Toll free: 866-669-3856 Authorization Prior Authorization
Providers Behavior
Fax: 952-853-8830 Submission: and Notification
(97154UB) *While
primewest.org/form
• Intervention authorization is not
s/authorization
– Higher required, we do
While authorization
Intensity: request that you
is not required we
Adaptive fax CMDE *
do request that you
Behavior
fax CMDE *
(0373T) Fax: 855-454-8155
• Intervention Fax: 855-454-
– 8155.
Individual:
January 2024
 6

Category of Blue Cross Blue Hennepin Medica Prime West South Country UCare United Healthcare
HealthPartners IMCare
Information Shield of Health Health Health Alliance
Minnesota
Observatio
n and
Direction
(97155UB)
• Family or
Caregiver
Training
and
Counseling
– Individual
(97156UB)
• Family or
Caregiver
Training
and
Counseling
– Group
(97157UB)
• Travel Time
(H0046UB)

Fax prior
authorization
requests to
Hennepin Health
at 612-677-6222.

Refer to Hennepin
Health’s website
for more
information about
prior authorization
requirements:
HennepinHealth.or
g

January 2024
 7

Category of Blue Cross Blue Hennepin Medica Prime West South Country UCare United Healthcare
HealthPartners IMCare
Information Shield of Health Health Health Alliance
Minnesota
UnitedHealthcare
Claims must be claims website has a
submitted variety of resources.
electronically For billing and
payment questions, go
Online resource to UHCprovider.com
Claims must be
Can use clearing tools are available to submitted
house but not help providers: UCare Claims and For a complete
electronically.
required. billing webpage has a description of
primewest.org/claim variety of resouces. processes, go to Care
South Country
Refer to the Claims must be s-submission Provider
Resources for Provider page has
website at submitted Administrative Guides
EIDBI providers a variety of online Allows use of third
All claims must be Hennepinhealth.or electronically. Clearinghouse and Manuals > View
Billing FAQ’s billing Medica resources. party billers with
submitted g for claims and options: online version >
Provider resoruces agreement
electronically billing resources.IMCare offers two primewest.org/cleari Chapter 9 Our Claims
Billing resources Providers can bill Claim tips and Partners with
using Availity. methods of free online nghouses Process
and supports Healthpartners directly resources PrimeWest, To submit electronic
All claims direct claims
or use an approved approved payments, complete
Availity has training submitted to submission through a Free online claim UHC Community Plan
clearing house All clearinghouse for the payment and
opportunities. Hennepin Health, web-based program, submission tools: EIDBI MN training:
Clearninghouses Prime west. remittance request
must be submitted Infotech Global, Inc. Minnesota Medicaid
may be used. forn in the provider
electronically. (IGI) (known as MN E- primewest.org/freeo EIDBI Program,
HEALTHEC is a portal. For support,
connect) or OfficeAlly nlineclaimssubmissi United Healthcare
free online claims email
ontool Community Plan
submission tool for EFT835@ucare.org
EIDBI billing and Minnesota
South Country
policy FAQ If further assistance
providers
is required, Claims: Claims,
providers can call: Billing and Payments
Provider Contact
Center: 866-431- Claims Services:
0802 866-633-4449

UCare Health Ride:

BlueRide: RideCare: 612-676-6830
Member
651-662-8648 952-883-7400 or 800-864-
Services: Member Services: Provide a Ride Member Contact
Transportation 218-327-6188 or
Member Services: 2157 or MTM (NEMT Vendor):
612-596-1036 or Services: Center:
services Toll free: Toll free: 866-567-7242 UCare Customer 888-444-1519
800-647-0550, 800-843-9536 952-992-2292 866-431-0801
866-340-8648 888-288-1439 Services:
option 1
TTY: 711 TTY: 711 612-676-3200 or
800-203-7225

January 2024
 8

Category of Blue Cross Blue Hennepin Medica Prime West South Country UCare United Healthcare
HealthPartners IMCare
Information Shield of Health Health Health Alliance
Minnesota
All phone and fax
numbers are the
Regular business same for after Call routing is
hours are Monday hours. Messages currently set up so
through Friday Phones answered 8
may be left. calls to the member or
from 8 a.m. to BH After Hours: a.m. to
24-hour provider services
All phone or fax 4:30 p.m. 800-848-8327 5 p.m. Monday
All phone or fax Secure messages NurseLine: numbers would
After-hours numbers are the All phone or fax through Friday.
numbers are the same may also be sent via 866-538-1226 automatically route to
phone number same for after
after hours.
numbers are the same Medica CallLink
the Provider Web TTY: 877-777- staff after hours
hours. After hours, after hours. NurseLine: Nurse Line answered
please contact the Portal. 6534
800-962-9497 after hours: 800-942-
HealthConnection Member Services:
7858
24/7 nurse line at Nurse Line: 888-269-5410
888-859-0202 Nurse24: 866-201-
4601
(toll free; TTY 711)
Members: Health
Plans for Minnesota
Members: Providers:
Members:
healthpartners.com/ins uhcprovider.com
liveandworkwell.com
urance/minnesota- Members: ucare.org
South Country
medical-assistance/
Website bluecrossmn.com HennepinHealth.o www.imcare.org Providers: primewest.org Health Alliance
Providers: UHC Community Plan
rg Providerexpress.co (mnscha.org) EIDBI MN training:
Providers: ucare.org/providers
m Minnesota Medicaid
healthpartners.com/pro
vider-public/ EIDBI Program,
United Healthcare
Community Plan
Minnesota

January 2024