Medica Provider News: January 2026

REQUIREMENTS: 1. PORTAL MIGRATION - By December 31, 2025: Billing team must ensure all staff have signed up for and tested access to Availity Essentials portal. Verify registration is complete for organization. Continue using secure provider portal for dates of service through December 31, 2025. For payer ID 75261 plans, ensure WebTPA is configured within Essentials. Beginning January 1, 2026, route all electronic transactions to Availity Essentials. 2. PAYMENT VENDOR CHANGES - By December 31, 2025: Billing team must register with Optum VPay (separate from Optum Pay) for self-funded plans under payer ID 71890. Email support@vpayusa.com or call 1-855-893-3029 to set up VPay ACH or Vcard payment. For all other plan types, verify Instamed is configured. Register with SDS as remittance vendor for payer ID 71890 plan types by contacting 1-855-297-4436 option 2 or stream.support@sdata.us. Remittances will NOT be available in Availity Essentials portal and must be accessed through SDS. 3. NETWORK CHANGES - Effective January 1, 2026: For Medica with SSM Health products (commercial and IFB/Marketplace members), update billing system routing: Behavioral health services now bill under payer ID 87726 (Medica Behavioral Health network). Chiropractic/physical health services now bill under payer ID 41161 (Optum Physical Health network). Update claim submission rules and provider alerts. Note: Changes do not apply to SSM Health Employee Health Plan. 4. ACA CHART REVIEW PREPARATION - Immediate: Billing and clinical staff must prepare to receive chart retrieval requests from Datavant (managing chart review on behalf of Medica and Optum). Requests will target 2025 dates of service for commercial small group and IFB members. Establish protocol for responding to Datavant at 1-877-445-9293 or chartreview@Datavant.com. DEADLINE: Complete all requested chart collection by March 31, 2026. Provide medical records, clinical notes, and reports as requested. Failure to provide documentation may result in coding gaps and inaccurate risk adjustment. 5. DEMOGRAPHIC VERIFICATION - By January 31, 2026: Review provider demographic information on Medica website and verify accuracy (name, specialty, address, telephone, clinic locations, facility information). Update NPPES (National Plan and Provider Enumeration System) information. Notify Provider Network Relationship Specialist of any changes in writing or via provider support email. Do not wait for BetterDoctor quarterly outreach. 6. PROVIDER DIRECTORY TRANSITION - Note for January 2026: New provider search tool "Find Care" will replace online provider directory. Review tool to ensure organization information is accurate before launch.