Medica Provider News: July 2025

IMMEDIATE ACTIONS (Effective July 1, 2025): (1) Billing team must update credentialing submission processes to clearly indicate locum tenens status and start/end dates for all provider submissions. (2) Ensure all credentialing applications include required health equity language fields from CAQH and Medica standard applications to avoid delays. (3) Monitor provider license expiration dates monthly; flag any expired licenses to Network Consultant immediately as administratively terminated providers will need to reapply. (4) Beginning October 1, 2025, expect recredentialing notices only when additional information is needed or recredentialing is denied (not routine approval notices). OCTOBER 1, 2025 ACTIONS: (1) Billing team must STOP using the Medical Injectables List and transition all prior authorization lookups to the Prime Therapeutics website (search by HCPCS code using Control-F function). Update billing software references and staff training. (2) For IONM procedures: Implement system rules requiring CPT codes 95940, 95941, and G0453 to be billed ONLY with Place of Service codes 19, 21, 22, or 24 AND accompanied by a Study Code. These codes must NOT be billed by the surgeon or anesthesiologist performing the procedure—flag claims with these providers as billing errors. Claims without proper POS/Study Code or billed by ineligible providers will be denied. (3) Update all encounter forms, billing software logic, and provider education materials to reflect IONM policy changes. (4) Transition website bookmarks and provider communications from wellfirstbenefits.com and mo-central.medica.com to mo-central.medica.com/Providers for accessing Medical management, Pharmacy services, and provider portal. By October 1, 2025: These URLs will no longer redirect.