Medica Provider News: February 2026

REQUIREMENTS: By February 28, 2026: Billing and prior authorization team must: 1. Update prior authorization submission workflow to route requests through correct portals based on service type: - Availity Essentials: General medical prior authorizations - Carelon portal: Radiology, cardiology, and musculoskeletal services prior authorizations - Navitus or Express Scripts by Evernorth portal: Prescription drug prior authorizations (depending on member benefit) - Prime Therapeutics portal or fax to (608) 252-0814: Medical benefit drug prior authorizations 2. Remove Availity Essentials from medical benefit drug prior authorization process 3. Train all staff submitting prior authorizations on new routing requirements 4. Document the new routing process in billing department procedures 5. Stop submitting admission notifications for labor and delivery cases (effective Jan 1, 2026) - no admission notification required for routine labor and delivery; only submit authorization requests for NICU admissions (continue to require) or extended stays beyond 5 days 6. Update claim appeals and adjustments process to use 2026 payer IDs from member ID cards Consequences of inaction: Prior authorization requests submitted to wrong portals will be delayed or rejected, potentially resulting in claim denials and payment delays. Continued submission of labor and delivery admission notifications after Jan 1, 2026 will be unnecessary and may cause processing delays.