Ng of this request. Fax form and any relevant documentation to: 612-884-2185 or 1-866-402-5018 For questions, call: 612-676-6705 Email: CLSintake ucare.org MEMBER INFORMATION Member Name Member ID Member Address PMI Member City, State, Zip Date of Birth CC INFO Member Phone.

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How to fill out the UCare U7829 online

The UCare U7829 form, also known as the Elderly Waiver DTR Notification, is essential for care coordinators assisting members with waiver services. This guide provides clear instructions on how to effectively complete this form online to ensure timely processing and compliance.

Follow the steps to successfully fill out the UCare U7829 form.

  1. Press the ‘Get Form’ button to access the UCare U7829 form and open it in your preferred editor.
  2. Begin filling out the 'Member Information' section. Enter the member's name, ID, address, city, state, zip code, and date of birth in the designated fields.
  3. In the 'CC Info' section, provide the member's phone number and select their gender from the given options.
  4. Complete the 'Care Coordinator' section by entering your name, phone number, email, and fax number.
  5. Indicate the 'New or Current EW Date Span' by filling in the start and end dates.
  6. In the 'Services/Procedures/Items Requested' section, select the appropriate option for denial, termination, reduction, or terminating EW eligibility.
  7. Provide a reason code and detailed comments in the 'DTR Comments' field, noting specific dates or details relevant to the request.
  8. Select a service description and fill in the frequency and rate per unit if negotiated.
  9. Enter the provider's name, NPI, phone number, and fax number in the corresponding fields.
  10. Once all sections are complete, review the form for accuracy and clarity. You can then save your changes, download the form, or print it for submission.

Complete your documentation online to ensure efficient processing of your request.

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