Training

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)

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

Class Dates and Times

• Apr. 9, 10 – 11:30 a.m.

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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

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.

Medica offers different Medicare plans to fit our members’ needs. This course will review information to assist providers in better understanding the different Medicare plans Medica has available.

We'll focus on:

• The differences between Medicare Advantage and Cost plans
• Changes for 2019
• 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