Medication Therapy Management Provider Information
The University of Minnesota Health Plan (UPlan) invites pharmacists to join the UPlan MTM Provider Network to provide MTM services to eligible University employees and their dependents across Minnesota, and to employees participating in the State of Minnesota SEGIP (State Employee Group Insurance Plan) Diabetes MTM Program.
MTM providers are needed throughout the state of Minnesota.
Pharmacists are eligible to become MTM providers in the UPlan network if they graduated during or after 1996, or have completed an approved continuing education course.
Application to Join the UPlan MTM Provider Network
Information for Network Provider
- The Complete UPlan MTM Benefit Program Design Statement (pdf)
- Frequently Asked Questions (pdf)
- UPlan MTM Policies and Procedures (Administrative Program) (pdf)
- General Instructions for Submitting MTM Claims (pdf)
- Key Contact Information for UPlan MTM Providers (pdf)
- MTM Fee Structure (Excel)
- UPlan MTM/SEGIP Program Comparison (pdf)
University of Minnesota UPlan MTM Program
UPlan Member Eligibility
UPlan members are eligible to participate in MTM services if they are currently taking four or more UPlan-covered prescription and over-the-counter medications for chronic conditions or are referred by their physician. A referral request form is available below.
UPlan Wellness Program
UPlan members who participate in the MTM program have the opportunity to earn points in the UPlan's Wellness Program. These points can be used toward a reduction on annual medical rates.
Note: There is no longer an enrollment form for UPlan MTM. To accumulate points toward a reduction in health care rates, the employee must participate in the UPlan's Wellness Program.
Prime Therapeutics LLC is the Pharmacy Benefit Manager for UPlan prescription claims. Pharmacists enrolled as providers in the UPlan MTM Network should consult the UPlan drug formulary when making recommendations for changes in a patient's medication therapy. The current University of Minnesota UPlan Formulary (pdf) lists the medications that are covered by the program.
UPlan Prior Authorization (PA), Step Therapy (ST) and Affordable Care Act (ACA) information
- Prior Authorization Program (pdf)
- Step Therapy Program (pdf)
- Prior Authorization and Step Therapy Criteria (pdf)
- Prior Authorization Forms
- ACA Preventive Medications (pdf)
- ACA Contraceptive Medications (pdf)
State Employee Group Insurance Plan (SEGIP) MTM Diabetes Program
As of June 1, 2013, the UPlan MTM Network is providing MTM services for State of Minnesota employees with diabetes. Eligible employees receive invitations to enroll. However, all SEGIP employees with a diagnosis of diabetes are eligible for the program, and credentialed network pharmacists may enroll any employees who fits the criteria for participation. Currently, spouses and covered dependents are not eligible for this program. For more information on program eligibility see SEGIP FAQs (pdf).
Links to State Website for SEGIP MTM Diabetes Program
- SEGIP MTM State Website
- SEGIP Program Letter to Pharmacists (doc)
- SEGIP Program Description for Pharmacists (doc)
SEGIP MTM Diabetes Management Program Forms and Documents
- SEGIP Member Participation Agreement (pdf)
- SEGIP Medication Record Form (pdf)
- SEGIP Health Screening Form (pdf)
- SEGIP Key Contact Information (doc)
SEGIP D5 Data Submission
- SEGIP D5 Letter (pdf)
- Asthma (doc)
- Diabetes (doc)
- Vascular (doc)
- Data File Instructions-EMR (doc)
- Date File Instructions-Excel (doc)
SEGIP Member Information
SEGIP Member Disenrollment Form
MTM Benefit Program Coordinator
B288 Mayo Memorial Building
420 Delaware Street S.E.
Minneapolis, MN 55455
308 Harvard Street S.E.
Minneapolis, MN 55455