Medica Provider News: June 2026

REQUIREMENTS: 1. By June 30, 2026: Billing and administrative staff who submit specialty drug prior authorizations for medical benefits must complete Medica's training on Prime Therapeutics portal submission. Attend one of two web-based sessions (June 9 or June 17, 2026) or review recorded webinar materials posted afterward. Contact Provider Service Center at 1-800-458-5512 for registration or questions. 2. By July 1, 2026: Update all prior authorization workflows to submit specialty medical benefit drug authorization requests through Prime Therapeutics Gateway portal instead of fax. This applies to SSM Health Employee Health Plan members, SSM Health Individual and Family Business members, and all other Medica members. Non-compliance will result in authorization delays and potential claim denials. 3. By July 1, 2026: Stop submitting claim appeals for payer ID 39113 through Medica's secure provider portal. After July 1, use the Claim Adjustment or Appeal Request Form and submit by fax or mail. This applies only to claims with dates of service on or before December 31, 2025. 4. By July 24, 2026: Clinic managers, site administrators, or schedulers identified in Medica's annual Patient Access to Practitioner Survey email (sent mid-June) must complete and submit the survey. Forward to appropriate staff if received in wrong department. This is required for Medica's NCQA accreditation. 5. By August 31, 2026: Migrate all daily administrative transactions (eligibility and benefits inquiries, claims status, authorization submissions, appeals submissions) from Medica's secure provider portal to Availity Essentials. Ensure all staff are trained on Availity portal access and know how to select correct payer names in the drop-down menu to match payer IDs. 6. By September 1, 2026: Medica's secure provider portal will be decommissioned. All non-legacy transactions must be completed through Availity Essentials. For claims with dates of service prior to January 1, 2026, and payer ID 39113, information will only be available through the Provider Service Center by phone. 7. Late June 2026: Prepare staff for new Provider Service Center telephony system. When calling 1-800-458-5512, have ready: organization tax ID, member group number, member ID number, and clearly state the primary purpose of the call (claim inquiry, authorization question, eligibility verification) for accurate routing.