Provider Training

Claim appeals and adjustments are an important tool to ensure proper claims payment! This webinar will review the process for submitting appeals, adjustments and supporting documentation to Medica.

We'll focus on:

• The different avenues for submission, and when each is appropriate
• When appeals and adjustment requests are appropriate
• Where to find the necessary forms on Medica.com
• Tips for making sure that your appeal or adjustment request contains the information that supports the desired outcome in an accessible format
• The options available if you disagree with a decision on an appeal or adjustment request

Appeal Adjustment and Record Submission Training (PDF)

Understanding all three components of a clean claim — submission, process and output — is important to ensure proper payment! This webinar will review all three in order to help you understand how they work together to facilitate the proper processing of claims.

We'll focus on:

• Submission policies and requirements
• 837P and 837I electronic transactions
• Provider remittance advices (PRAs)
• Common denial reasons
• How to request claim adjustments and appeals

Life of a Claim Training (PDF)

This is a recorded training that focuses on 2024 state-specific Medicare plan changes. For plan year 2024, Medica can no longer offer Medicare Cost plans (i.e., the Medica Prime Solution® product) in 51 counties across Nebraska, North Dakota, South Dakota and Missouri. This training provides an overview of this transition; the Medicare Advantage products offered in place of Medicare Cost in the 51 counties; and resources available to determine eligibility, coverage guidelines and other valuable details to help ensure a smooth transition for these members. 

Medicare Advantage: Product Overview and Resources for NE, ND and SD Providers (MP4)

• Provider Model of Care Training ‐ Medicare Advantage Special Needs Plans (PDF)
• Minnesota Provider Model of Care Attestation 
• North Dakota Provider Model of Care Attestation

Having resources at your fingertips is a great way to save you time! We routinely update our provider resources. This webinar will walk you through our self-service options, including resources on medica.com.

We'll focus on:

• Determining member eligibility
• Verifying if utilization management and reimbursement policies apply to services being billed
• Verifying how a claim processed
• Next steps for claims (e.g. appeals or adjustments)

Navigating Provider Resources (PDF)

Medica Prime Solution® is Medica's cost-sharing plan with Medicare that continues to steadily gain membership. This training will review details of how this Medicare Cost product works, where it will be offered for the 2023 plan year, and how it compares to other Medicare products offered by Medica. Also covered in this training: valuable resources available on Medica.com that can be used to ensure appropriate billing practices and claim processing for this product.

Cost for Providers

Prime Solution: Medica's Cost Plan for Medicare Members (MP4)

This training will walk providers through requirements as well as tools and services available to assist with billing along with an overview of housing stabilization benefits; getting set up as a EW or housing stabilization provider; role of the care coordinator and role of Medica's Provider Service Center; how to obtain an authorization; the claims submission process and what to do if a claim is not processed as expected.

Set-up and Billing for EW and HSS Providers (PDF)