Medica Provider News: April 2026

REQUIREMENTS: - By June 1, 2026: Billing team must register with Prime Therapeutics Gateway portal and complete staff training planned for June 2026. Contact Medica Provider Service Center at 1-800-458-5512 for portal access and credentials. - By July 1, 2026: Stop submitting prior authorization requests for specialty medical benefit drugs to Medica by fax. All requests must be submitted through Prime's Gateway portal for SSM Health Employee Health Plan members and Medica IFB members. - Immediately: Update billing system to remove prior authorization requirement for CPT 29826 (arthroscopic subacromial decompression) for dates of service on or after February 1, 2026. Do not hold claims for prior auth on this procedure. - Before July 1, 2026: Train all clinical and billing staff on the new Prime Therapeutics submission process, including portal access procedures and contact information (1-800-458-5512). - Document the transition date and new authorization vendor in billing workflows to prevent claim denials due to incorrect submission routing.