August 2015
General News
Effective July 1, 2015:
Medica with Mayo Clinic Health System ACO expands
Effective July 1, 2015, Medica has expanded its provider network for the “Medica with Mayo Clinic Health System” health plan option available through My Plan by MedicaSM or offered alongside a Medica Choice® Passport plan. This accountable care organization (ACO) expansion means Medica can now offer this option to employer groups located in 18 counties in southern Minnesota. As of July 1, this ACO gives Medica members access to nearly 20 hospitals and 60 clinics in the greater Eau Claire, Mankato and Rochester areas. Medica with Mayo Clinic Health System was previously available in four counties in western Wisconsin.
Providers in this ACO plan include:
- Mayo Clinic Employee and Community Health (delivering primary care services in Rochester and Kasson, Minn.)
- Mayo Clinic Health System locations in Minnesota and Wisconsin
- Northfield Hospital and Clinics
- Winneshiek Medical Center
- Winona Health
Medica members can see any provider in the Medica with Mayo Clinic Health System network without a referral. If network providers in this Medica accountable care system product determine that a member needs specialty care at Mayo Clinic in Rochester, Minn., they will make arrangements for the care. View the Medica with Mayo Clinic Health System fact sheet »
PCA agencies to receive data-validation reports in August
Medica will soon send an annual data-validation request by e-mail to its personal care assistant (PCA) provider network. By doing so, Medica ensures that it has accurate demographic information for PCAs, which is essential for prompt and accurate claims payment.
While agencies are encouraged to submit data changes to Medica as they occur throughout the year, this data-validation effort allows agencies to verify current Medica information. Having updated information will not only improve Medica members' experience, but it will have the potential to increase referrals for services to PCA agencies. As an example, as part of this annual data-validation project, PCA agencies will be asked to provide information regarding cultural and linguistic services offered by agency staffs, which would obviously appeal to populations of color.
Validation notices should arrive in August 2015, with a two-week deadline for PCA agencies to respond. Instructions will be provided for verifying the data and making changes using the Provider Demographic-Update Online Tool (PDOT) available at medica.com in the Providers section under Electronic Transactions (this secure login is available to designated Primary and Secondary Administrators for provider groups). To enter the electronic tools section, a username and password is required. Email portal registration questions to Medica.
Medica would like to extend a sincere thank-you to PCA agencies for taking the time to help keep these records up-to-date.
Annual notice:
Compliance, FWA trainings required for Medicare providers
The Centers for Medicare and Medicaid Services (CMS) requires that Medicare providers complete general compliance training and fraud, waste, and abuse (FWA) training. The training requirement applies to all organizations that provide healthcare services or administrative services for Medicare beneficiaries, and also applies to the organizations' downstream and related entities. Please note that Medicare-certified (or deemed) providers are exempt from the FWA portion of the training, but are still required to complete general compliance training.
Medica makes the Medica Standards of Conduct, Compliance Reporting Policy, general compliance training and FWA training available on medica.com. Medica also requires that a compliance officer or equivalent person for a provider group complete and sign a Compliance Program Attestation and return it as instructed by August 31, 2015.
To access the Provider General Compliance Training, Provider FWA Training, and Compliance Program Attestation form, scroll to the bottom of the medica.com Providers home page, click on Fraud and Abuse (under Resources), and then click on the Provider Training tab at the top. Learn more about Compliance and FWA and take the trainings »
Beginning in 2016, according to federal regulations, providers must utilize the general compliance and FWA training materials created by CMS. Therefore, in preparation for the 2016 calendar year, the training presentations provided on the Medica website are a copy of the CMS training documents. See more from CMS about Medicare compliance »
As a reminder, training is required at the time of a Medicare provider's initial contract and then annually thereafter. Providers should maintain records of all training. Records should include dates and methods of training, materials used for training, and training logs identifying employees who received training. Medica, CMS, or agents of CMS may request such records to verify that training occurred.
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Clinical News
Effective June 17, 2015:
Medica makes UM policy change
Medica has revised the following utilization management (UM) policy that requires prior authorization, effective beginning with June 17, 2015, dates of service. This change applies to all Medica products including government products unless a particular health plan (whether commercial, Medicare or Medicaid) requires different coverage.
Comparative genomic hybridization (CGH) microarray testing
Medica has reviewed CGH microarray technology for prenatal testing and has determined that this technology will now be considered for coverage but does require prior authorization. CGH microarray prenatal testing is considered medically necessary when the expectant mother will be undergoing an amniocentesis or chorionic villus sampling for another suspected prenatal indication (e.g., suspected aneuploidy; suspected structural abnormality) and previous medical history suggests the possibility of an unconfirmed genetic syndrome. For additional criteria, refer to the UM policy titled “Comparative Genomic Hybridization (CGH) Microarray Testing.”
CGH microarray testing is a laboratory test performed to detect unbalanced genomic copy number variation such as microdeletions and/or microduplications at a higher resolution level than conventional genetic evaluation (karyotype analysis or fluorescence in situ hybridization (FISH). Some of these gains or losses might be associated with neurodevelopmental disorders.
Through prior authorization for procedures, Medica aims to support members and providers in making evidence-based decisions about appropriate, medically necessary care. As a reminder, Medica requires that providers obtain prior authorization before rendering services. If any services requiring prior authorization are submitted for payment without obtaining a prior authorization, the related claim or claims will be denied as provider liability.
The complete text of the policy that applies to the determination above is available online or on hard copy:
- See Medica's UM policies; or
- Call the Medica Provider Literature Request Line for printed copies of documents, toll-free at 1-800-458-5512, option 1, then option 5, ext. 2-2355.
Effective September 1, 2015:
Medica to make UM policy changes
Medica will soon revise the following utilization management (UM) policies that require prior authorization, effective beginning with September 1, 2015, dates of service. These changes will apply to all Medica products including government products unless a particular health plan (whether commercial, Medicare or Medicaid) requires different coverage.
Sacral nerve stimulation (SNS)
Medica has reviewed SNS for urinary and fecal incontinence and has determined that incision for implantation of the permanent neurostimulator electrodes (CPT 64581) will be the primary trigger for prior authorization. Upon receipt of a request for authorization of permanent electrode placement, whether for a trial of SNS or permanent placement of the stimulator, Medica will review for medical necessity of SNS, including the lead, the stimulator and all associated expenses. A trial of SNS using percutaneous implantation of the neurostimulator electrode (CPT 64561) will no longer require prior authorization. Refer to the Medica UM policy titled “Sacral Nerve Stimulation” for applicable medical necessity criteria.
Reconstructive eyelid, brow lift procedures
Medica has reviewed reconstructive blepharoplasty (upper or lower eyelid), blepharoptosis repair (upper eyelid) and brow lift and made changes to the medical necessity requirements for these procedures. Visual field measurements will no longer be accepted as documentation of visual impairment for blepharoplasty (upper) and blepharoptosis repair. Medica will continue to require either marginal reflex distance (MRD) or central vision measurements.
Brow lift will only be considered medically necessary when performed in conjunction with a medically necessary upper lid blepharoplasty and documentation must state why the functional visual impairment cannot be correctly by blepharoplasty alone. For additional criteria, refer to the UM policy titled “Reconstructive Blepharoplasty (Upper or Lower Eyelid), Blepharoptosis Repair (Upper Eyelid) and Brow Lift.”
The complete text of the policies that apply to the determinations above will be available online or on hard copy:
- See Medica's UM policies as of September 1, 2015; or
- Call the Medica Provider Literature Request Line for printed copies of documents.
Effective September 1, 2015:
Medical policies and clinical guidelines to be updated
Medica will soon update one or more utilization management (UM) policies, coverage policies, Institute for Clinical Systems Improvement (ICSI) guidelines, and Medica clinical guidelines, as indicated below. These policies will be effective September 1, 2015, unless otherwise noted.
UM policies — Revised
These versions replace all previous versions.
| Name |
Policy number |
| Abdominoplasty/Panniculectomy |
III-SUR.13 |
| Breast Implant Removal, Revision, or Reimplantation |
III-SUR.11 |
| Comparative Genomic Hybridization (CGH) Microarray Testing (effective 6/17/15) |
III-DIA.09 |
| Female Breast Reduction Surgery- Reduction Mammoplasty |
III-SUR.27 |
| Hip Arthroplasty/Replacement and Hip Resurfacing (revised to reflect use of MCG Care Guidelines®) |
III-SUR.40 |
| Knee Arthroplasty/Replacement |
III-SUR.41 |
| Male Gynecomastia Surgery |
III-SUR.31 |
| Otoplasty |
III-SUR.33 |
| Reconstructive Blepharoplasty (Upper or Lower Eyelid), Blepharoptosis Repair (Upper Eyelid) and Brow Lift |
III-SUR.29 |
| Rhinoplasty Procedure with or without Septoplasty |
III-SUR.04 |
| Sacral Nerve Stimulation (SNS) |
III-DEV.22 |
| Spinal Cord Stimulation of the Dorsal Column for Treatment of Pain |
III-SUR.23 |
| Vagus Nerve Stimulation (revised to reflect use of MCG Care Guidelines) |
III-DEV.24 |
Coverage policies — Revised
These versions replace all previous versions.
| Name |
| Bladder Cancer Screening, Diagnosis, and Monitoring Using Ancillary Urinary Tests |
| Gene Expression Profiling Allays for Predicting Colon Cancer Recurrence Risk |
| Genetic Testing: ScoliScore® Adolescent Idiopathic Scoliosis (AIS) Prognostic Test |
| Magnetic Resonance Spectroscopy (MRS) |
| Repetitive Transcranial Magnetic Stimulation (RTMS) Therapy |
These documents will be available online or on hard copy:
The value of monitoring controlled-substance prescribing
Any health care provider who writes prescriptions is continuously walking a tightrope when it comes to pain management. Prescribers as a group are keenly aware of the benefits of adequate pain control as well as the risks associated with misuse and abuse of narcotic pain medications. For those who may have missed these reports, the human impact of non-medical use of narcotic drugs increased 300 percent in 20 years to result in more than 15,500 deaths in 2009. Also, for each death reported, there are 10 treatment admissions and 21 emergency room visits, according to the U.S. Food and Drug Administration (FDA). From an economic standpoint, annual societal costs of opioid abuse have skyrocketed to $55.7 billion, which includes health care, work and criminal justice costs.
A valuable tool available to prescribers, pharmacies, and in some states, prescriber delegates, is each state’s prescription drug monitoring program. A monitoring program is populated by prescription data for all dispensed Schedule II through V controlled substances (and butalbital in Minnesota), regardless of where the dispensing took place (prescriber office or pharmacy) or whether insurance was billed. This allows for a much more comprehensive picture of controlled-drug dispensing than before. As of 2015, all but two states had monitoring programs online, and 22 states share data to allow users in one state to access data in other states.
Far from wasting prescriber time, prescribers who had used their state monitoring program saw a reduction in investigation time of 80-93 percent. There are also studies that have shown associations between their use and a slower rate of increase in opioid abuse and treatment admissions. Some key items to look for in monitoring program data include changes in refill patterns, such as repeated early or overlapping refills; increases in quantity or dose received; and receiving prescriptions from multiple providers or multiple pharmacies.
Most physicians who use monitoring programs reported doing so when abuse or diversion was suspected, but the National Institute on Drug Abuse (part of the National Institutes of Health, or NIH) advises that prescriber screening for prescription drug abuse is key, and this screening can be incorporated into routine medical visits for patients who are taking long-term opioids.
Medica strongly endorses the use of monitoring programs. Available at the following websites, these programs are an important tool in helping to curb any misuse of controlled-substance prescribing:
Annual notice:
Medica monitors Quality Improvement program goals for 2015
Medica prepares an annual Quality Improvement Work Plan to outline key quality improvement (QI) activities for the year. The work plan encompasses clinical quality, service quality, provider quality and patient safety, as well as community collaborations and ongoing quality monitoring activities. As of second quarter, the 2015 QI Work Plan features 20 individual quality improvement activities, 19 ongoing quality monitors, and six community collaborations. More QI activities can potentially be added throughout the year.
Some Work Plan initiatives that may interest medical groups include activities to:
- improve well-child visit rates for a specific member population
- increase use of valid colorectal cancer screening tests for all member populations
- improve performance on Healthcare Effectiveness Data and Information Set (HEDIS) osteoporosis measure
- measure effectiveness of complex case management and disease management programs
The Medica QI program supports the Medica mission to meet its customers' needs for health plan products and services. The QI program's purpose is to identify and implement activities that will improve:
- member care, service, access and/or safety;
- service to providers, employers, brokers and other customers and partners; and
- Medica internal operations.
This program encompasses a wide range of clinical and service quality initiatives affecting Medica members, providers, employers and brokers, as well as internal stakeholders throughout Medica.
Medica evaluates its QI program annually, reviewing the year's QI activities and assessing progress toward goals. Medica also looks at its QI committee structure, program resources, and key challenges and barriers encountered during the year. Each year's program evaluation forms the basis of the next year's work plan.
The Medica Quality Improvement Subcommittee (QIS) of the Medical Committee of the Medica Board of Directors directs and oversees QI program implementation. QIS serves as a peer-review body, receiving and reviewing aggregate data on all aspects of clinical and service quality. QIS approves program activities, recommends policy changes and follows up on improvement opportunities.
For more details about the Medica QI program:
- Visit the Providers section of medica.com under "Quality and Cost Programs" »
- Call the Medica Provider Literature Request Line for printed copies of documents.
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Pharmacy News
Effective July 1, 2015:
Medica to update commercial, Marketplace, MHCP drug lists
Medica has reviewed the following products, with their respective coverage status to be effective July 1, 2015, unless otherwise noted. As indicated in the table below, these changes will apply to the Medica Commercial Preferred Drug List; the new Marketplace Preferred Drug List for individual and family business (IFB) members and small group plan members who purchase health plans on state exchanges; and the Medica List of Preferred Drugs for Minnesota Health Care Programs (MHCP). The Medica MHCP formulary applies to the following products: Medica Choice CareSM (including Minnesota Senior Care Plus program, or MSC+), Medica MinnesotaCare, Medica AccessAbility Solution® (Special Needs Basic Care program, or SNBC), and Medica DUAL Solution® (Minnesota Senior Health Options program, or MSHO), for non-Part D drugs. These changes will not apply to the Medica Medicare Part D formulary.
View the full table of changes »
Medica drug formularies are available online or on paper:
Medication request forms
A uniform formulary exception request form should be used when requesting a formulary exception. It is important to fill out the form as completely as possible and to cite which medications have been tried and failed. This includes the dosages used and the identified reason for failure (e.g., side effects or lack of efficacy). The more complete the information provided, the quicker the review, with less likelihood of Medica needing to request more information. To request formulary exceptions, providers can:
Effective July 1, 2015:
Medica updates drug UM policies
Medica has recently updated the following drug utilization management (UM) policies, effective with July 1, 2015, dates of service.
Drug UM (prior authorization) policies — Revised
These versions replace all previous versions.
| Name |
| dalfampridine (Ampyra®) |
| apomorphine (Apokyn®) |
| darbepoetin (Aranesp®) |
| pasireotide (Signifor®, Signifor LAR®) |
| itraconazole (Sporanox®, Onmel®) |
| buprenorphine and buprenorphine/naloxone (Subutex®, Suboxone®) |
| omalizumab (Xolair®) |
| topical tretinoin products |
| mercasermin (Increlex®) |
These updated drug UM policies are available online or on hard copy:
Effective September 1, 2015:
Medica to implement new drug UM policy
Medica will soon implement the following drug utilization management (UM) policy, effective with September 1, 2015, dates of service.
Drug UM (prior authorization) policies — New
| Name |
| efinaconazole (Jublia®) |
This new drug UM policy will be available online or on hard copy:
Effective September 1, 2015:
Medica to update drug UM policies
Medica will soon update the following drug utilization management (UM) policies, effective with September 1, 2015, dates of service.
Drug UM (prior authorization) policies — Revised
These versions will replace all previous versions.
| Name |
| ledipasvir/sofosbuvir (Harvoni®) |
| simeprevir (Olysio®) |
| sofosbuvir (Sovaldi®) |
| ombitasvir/paritaprevir/ritonavir with dasabuvir (Viekira Pak®) |
These updated drug UM policies will be available online or on hard copy:
Effective September 19, 2015:
Medica to implement claims review for medical benefit drugs
Medica is committed to maximizing patient care in the most appropriate and affordable manner based on clinically accepted standards. With this commitment in mind, Medica has enhanced its current relationship with Magellan Rx Management to implement a comprehensive set of prospective (pre-payment) edits for drug claims adjudicated under the medical benefit.
Effective with September 19, 2015, dates of service, Medica will implement a new claims-review program for medical benefit drugs, to be administered by Magellan Rx. The Magellan Rx clinical claims-edit program includes a comprehensive list of high-cost medical injectable drugs that has been developed based on eligible medical diagnosis and maximum units supported by clinical practice standards. The clinical edits based on eligible diagnosis and maximum units will be applied to the medical claims, allowing payment according to evidence-based criteria as well as the number of units Magellan previously approved through prior authorization. This also ensures that billed drugs are used according to their U.S. Food and Drug Administration (FDA) label and Compendia-approved uses.
This new program will apply to Medica commercial and Minnesota Health Care Programs (MHCP) members. It will not apply to Medicare and individual and family business (IFB) members.
If Medica denies claims for medical benefit drugs, they will be denied as provider liability. Providers will have 60 days from the date of denial to submit a claim appeal.
View the full list of medications included in this new claims-review program »
There will also be corresponding Medical Pharmacy Claims-Edit Policies for each of the drugs included in this program. Access them through medica.com.
As a reminder, for medical pharmacy drugs that require prior authorization, providers should obtain authorization prior to the administration of these drugs. For these drugs, Medica denies claims as provider liability if providers have not obtained an authorization before the drug’s administration. Providers have 60 days from the date of the claim denial to submit an appeal and supply supporting documentation as required to determine medical necessity. View previously published details about drugs requiring prior authorization » (pp. 6-9).
Effective September 1, 2015:
Changes to Medica Part D drug formularies
Medica posts changes to its Part D drug formularies on medica.com 60 days prior to the effective date of change. The latest lists notify Medicare enrollees of drugs that will either be removed from the Medica Part D formulary or be subject to a change in preferred or tiered cost-sharing status effective September 1, 2015. Medica also notifies affected Medica members in their Medicare Part D Explanation of Benefits (EOB) statements mailed out monthly. View the latest Medicare Part D drug formulary changes »
Medica periodically makes changes to its Medicare Part D formularies: the Part D open formulary (4-tier + specialty tier) and the Part D closed formulary. The Medica Medicare Part D drug formularies are available online or on paper:
Medication request forms
A medication request form should be used when requesting a formulary exception. It is important to fill out the form as completely as possible and to cite which medications have been tried and failed. This includes the dosages used and the identified reason for failure (e.g., side effects or lack of efficacy). The more complete the information provided, the quicker the review, with less likelihood of Medica needing to request more information. To request formulary exceptions, providers can:
- Download a coverage determination form.
- Call MedImpact at 1-800-788-2949.
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Network News
‘Lag,’ quarterly PCR checks to be mailed in July, August
Medica plans to mail final 2014 physician contingency reserve (PCR) distribution checks, or "lag" checks, to providers in late July 2015. Medica returned 100 percent of the PCR withhold for the Medica Prime Solution® Medicare product for 2014, including the lag return. The final 2014 distribution will include PCR withheld from claims with dates of service that fell outside the 90-day submission window for each quarter of last year. The July 2015 distribution will include PCR for claims payments processed through June 30, 2015, plus interest.
In addition, the PCR payment for the first quarter of 2015 for the Medica Prime Solution product is expected to be mailed by the end of August 2015. This represents a 100-percent return of the first-quarter 2015 PCR withhold, plus interest. Checks will cover PCR withheld for claims with dates of service of January 1, 2015, through March 31, 2015, and dates paid of January 1, 2015, through June 30, 2015.
Note: Medica began processing claims with a 2 percent payment reduction in April 2013 due to federal sequestration legislation. The 2 percent sequester reduction was in addition to the standard PCR withhold amount for Medica Prime Solution claims. This 2 percent cut will not be included in PCR returns.
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Administrative News
Clarification: Prior authorization requests and ICD-10 codes
Medica previously announced that its Prior Authorization Request Form was updated to include ICD-10 diagnosis codes. However, ICD-10 codes should not be used yet. Based on when they are submitted to Medica, prior authorization requests need to include the proper diagnosis codes as follows:
- Requests submitted prior to October 1, 2015, should continue to include ICD-9 codes, not ICD-10.
- Requests submitted on or after October 1, 2015, will need to include ICD-10 codes.
View the corrected Prior Authorization Request Form »
To confirm what was previously published, if a prior authorization was obtained prior to October 1, 2015, for services continuing until October 1, 2015, or beyond, and the authorization was initially approved with an ICD-9 code, the authorization will continue to be in effect as confirmed in each case by Medica.
(Update to "Prior authorization requests to require ICD-10 codes" article in the July 2015 edition of Medica Connections.)
Effective September 19, 2015:
Overpayment detection program to prospectively review claims
Medica will soon modify its existing enhanced overpayment detection and recovery program, launched in 2013, to prospectively review claims (pre-payment). This change will be effective beginning with September 19, 2015, dates of processing. Currently, application of these claim edits occurs retrospectively (post-payment).
Waste and error prevention and detection procedures — such as those of the enhanced Medica overpayment detection and recovery program — are required by the Centers for Medicare and Medicaid Services (CMS) as well as the Minnesota Department of Human Services (DHS) for contracted health plans such as Medica. Providers will continue to have the ability to appeal payment decisions by following the standard Medica appeal process.
(Update to "Medica to enhance overpayment detection, recovery program" article in the March 2013 edition of Medica Connections.)
Effective July 5, 2015:
Medica revises reimbursement policies
Medica has recently updated the reimbursement policies indicated below, effective with July 5, 2015, dates of processing. Such policies define when specific services are reimbursable based on the reported codes.
Reimbursement policies — Revised
These versions replace all previous versions.
| Name |
| Ambulance (updated code list) |
| From-To Date (updated code list) |
This revised policy is available online or on hard copy:
Using correct cover sheet for electronic claims submission
As a reminder, providers should use the correct cover sheet related to electronically submitted claims. When providers submit the wrong form, it results in delayed claims processing and payment. There are two types of cover sheet to keep in mind: One for claim attachments and one for claim appeals. The Minnesota Administrative Uniformity Committee (AUC) has appropriate forms available online.
Providers should use an attachment cover sheet only for initial electronic claim submissions when they have attachments. View the AUC Uniform Cover Sheet for Health Care Claim Attachments »
Providers should use the claim appeals cover sheet only for appeals — i.e., when providers have a request to reconsider previously adjudicated claims. View the AUC Appeal Request Form » or the Medica Claim Appeal Request Form »
Updates to Medica Provider Administrative Manual
To ensure that providers receive information in a timely manner, changes are often announced in Medica Connections that are not yet reflected in the Medica Provider Administrative Manual. Every effort is made to keep the manual as current as possible. The table below highlights updated information and when the updates were (or will be) posted online in the Medica Provider Administrative Manual.
| Information updated |
Location in manual |
When posted online in manual |
Guidelines for billing observation services, based upon rules/guidelines published by CMS, other payers and MCG (formerly known as Milliman Care Guidelines), to communicate:
- The definition of observation services
- Appropriate time frames for observation services
- Appropriate billing for observation in conjunction with other services
- New observation notice requirement in Minnesota*
|
“Billing and Reimbursement" section, in "Claim Submission Requirements for Facilities" subsection, under "Submission Info" |
July 2015 (effective 9/1/15) |
For the current version, providers may view the Medica Provider Administrative Manual online »
*Note: Effective August 1, 2015, the Minnesota Department of Health will require hospitals to provide oral and written notice to each patient the hospital places in observation status of such placement within 24 hours. This is based on newly passed Minnesota statutes. For more information on this notice requirement and the full text of the new law, providers should refer directly to the Minnesota statutes (section 144.586).
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PPO News
Latest UHC provider bulletin available online
UnitedHealthcare (UHC) has published the latest edition of its Network Bulletin (June 2015). Highlights that may be of interest to LaborCare® network providers include:
- Process clarification on overpayment notifications mailed out
- Genetic testing review process updated — effective in June 2015
- Clinical data submission requirement — effective in July 2015
View the June 2015 UHC provider bulletin.
Wisconsin Medicaid news online for SelectCare providers
Medica SelectCareSM providers in the Wisconsin Medicaid provider network — which is administered by UnitedHealthcare Community Plan of Wisconsin and serves Wisconsin BadgerCare Plus and Medicaid SSI members — are able to access information online that is specific to Medicaid and applies to this network. Refer to the UHC Community Plan website »
This website for Wisconsin Medicaid providers includes a searchable provider directory, quarterly newsletters, monthly bulletins, and other helpful documents. It also connects to “UnitedHealthcareOnline,” a provider portal that allows provider offices to verify eligibility, check claim status, and submit adjustments or corrected claims.
Other resources:
Providers who have any service-related questions may call UnitedHealthcare Community Plan of Wisconsin toll-free at 1 (877) 651-6677. Providers interested in joining the SelectCare network may call SelectCare Provider Services at 1-800-858-9060, option 1, or contact Medica Network Management by e-mail.
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