Provider Training

This course will focus on process, policy and payment changes that are being implemented at Medica due to the COVID-19 pandemic including:

• Telehealth/virtual care policies
• Reimbursement
• Prior authorizations

There will also be time at the end of the training for a question and answer session.

Resources for Providers Training (PDF)

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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)

Resources for Providers Training (PDF)

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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)

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Elderly Waiver (EW) providers serve an important function in the care of Medica members. The services these providers offer promote community living and independence while giving people the support they need.

Working with a health plan can offer a variety of challenges, particularly for EW providers, and this training will walk providers through the requirements as well as the tools and services available to assist.

We’ll focus on:

• Getting set up as an Elderly Waiver provider
• The role of the Care Coordinator
• Obtaining an authorization
• The claims submission process
• The role of the Provider Service Center
• What to do if a claim does not process as expected

There will also be time at the end of the training for a question and answer session.

Class

• Elderly Waiver Providers Training Guide (PDF)
  

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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)

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Medica offers different Medicare and Medicaid plans (in the state of Minnesota) to fit member needs. This course will review information to assist providers in better understanding the Medicare and Minnesota Health Care Programs (MHCP) plans Medica has available, such as:

• The differences between Medicare Advantage and Cost plans
• Features of Medica’s MHCP plans for Special Needs, MSHO and Senior Care Plus
• Changes for 2020
• When Medica follows Centers for Medicare and Medicaid Services (CMS) guidelines
• When to bill Medica vs. Medicare as primary payer
• Upgraded services offered by plans
• Billing requirements and reimbursement

Medica Medicare Products Training (PDF)

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