🚨 Aetna Medicare Authorization UpdateProviders serving Aetna® Medicare members in NJ, NY, PA, and WV should be aware of important changes to authorization workflows:
🔹 Home Health Services
Authorizations must now be submitted through EviCore via the CareCore National portal
🔹 Post-Acute Care \(SNF & Inpatient Rehab\)
Authorizations must be initiated through the MedSolutions portal
🔹 IFP Members Update
EviCore will no longer manage authorizations for Individual & Family Plans \(IFP\) as of 1/1/2026
🔹 Vascular Intervention Program Changes
The following CPT codes have been removed effective immediately:
37246, 37247, 37252, 37253
📌 Providers should review internal workflows and ensure teams are aligned with these updates to avoid delays in patient care and reimbursement.
#ManagedCare #HealthcareOperations #PriorAuthorization #Aetna #MedicareAdvantage #PostAcuteCare #HomeHealth #RevenueCycle #HealthcareCompliance #ProviderSupport #HealthcareLeadership
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Navigating complex health conditions can be challenging—but the right support makes all the difference. Care Management programs are designed to provide personalized, one-on-one support through experienced case managers, including nurses and social workers who understand the clinical and social determinants impacting patient care.Through comprehensive care coordination and health coaching, members can access the guidance they need to improve outcomes, manage chronic conditions, and better navigate the healthcare system.
For example, Aetna Better Health of Florida, Care Management services offer:
✔ Individualized care plans
✔ Dedicated case managers
✔ Coordination across providers and services
✔ Support for complex and chronic conditions
For providers and partners, understanding and leveraging these programs is key to improving quality metrics, reducing utilization, and enhancing patient satisfaction.
🔗 Learn more about eligibility, services, and health programs here:
Care Management \| Aetna Medicaid Florida
For additional questions or partnership opportunities, please contact Patti Gardner at GardnerP\@aetna.com
#CareManagement #PopulationHealth #Medicaid #ValueBasedCare #CaseManagement #HealthcareCoordination #ChronicCareManagement #HealthEquity #ManagedCare #FloridaHealthcare #ProviderNetwork #MCCA #AetnaBetterHealth
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We’ve Jumped on the AI Trend!At @Managed Care Consultants of America, we decided to have a little fun and turn our team into AI caricatures — and let’s just say… the results are spot on 😄
We love blending innovation with personality — because while we take compliance, billing, and consulting seriously… we also know how to have a little fun as a team.
Let the guessing game begin! 🎭
Now it’s your turn! 👀
Can you guess who’s who? Drop your guesses in the comments below ⬇️
The below are all pictured can you guess who is who?
@[Alana Hanson-Williams, BSW](urn:li:person:Phufs6eVo3), @[Tabitha Faulk, BSN](urn:li:person:-m2UCc5eFB), @[Melanie Paulk](urn:li:person:BkEEJ4mbu1),
@[Christopher Langebrake](urn:li:person:XizlKgIoBj), @[Destiny Quinones, BSW, CEO](urn:li:person:bf2g6WOE44), @[Jeanine Rockett-Deveney, LPN,FAACM,MHCC-C](urn:li:person:OjDjVXXzu5), @[Nanette Johnson-Smith](urn:li:person:ffNTuFa6iz), @[Nikole Blackman, BSW](urn:li:person:0SAscLjfgW)
#ManagedConsultantsOfAmerica #HealthcareConsulting #AITrend #TeamSpotlight #GuessWho #HealthcareLeaders #SeniorCare #PostAcuteCare #InnovationInHealthcare #LinkedInFun #TrendingNow
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We’re grateful to the @Texas New Mexico Hospice & Palliative Care Organization for the warm welcome and the opportunity to connect with so many dedicated professionals committed to compassionate end-of-life care. At Managed Care Consultants of America, it’s always an honor to spend time with organizations and leaders who are making a meaningful difference for patients, families, and care teams every day. Conferences like this remind us how powerful collaboration and shared knowledge can be in strengthening the hospice community.
Thank you to the @Texas New Mexico Hospice & Palliative Care Organization for hosting such a valuable event and for your continued leadership and advocacy for hospice providers. We appreciate the opportunity to be part of the conversation and look forward to continuing to support this incredible community.
#ManagedCareConsultantsOfAmerica #HospiceCare #TexasHospiceAssociation #HealthcareLeadership #HospiceCommunity #HealthcarePartnerships
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Texas Providers: Start-of-Year Billing Alert – Wellcare by @Superior HealthPlan Providers serving Wellcare by Superior HealthPlan members should be aware of important 2026 billing changes following the transition of Medicare-Medicaid Plan \(MMP\) members at the start of the year.
Key reminders to avoid claim denials and delays:
\* All services on or after January 1, 2026 must be billed using the new 2026 Wellcare member ID
\* Verify eligibility prior to claim submission
\* Do not submit claims spanning December 2025 and January 2026—claims must be split by year and plan
\* New prior authorizations are required for services beginning January 1, 2026 or later
\* Existing MMP authorizations will transfer and be honored if they extend into 2026 \(no resubmission needed\)
Eligibility can be verified via Wellcare’s Provider Portal or Availity Essentials. Provider Services support is available at 1-855-445-3572. Staying proactive with eligibility checks and claim submission rules can help ensure timely reimbursement in 2026.
🔗 More details: https://lnkd.in/eXCbidWb
#TexasProviders #ManagedCare #HealthcareBilling #DualEligible #MedicareAdvantage #ClaimsProcessing #ProviderRelations #Medicaid
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Attention home health providers: VA Expands Access to Home & Community-Based Care for Veterans
The Department of Veterans Affairs announced a major enhancement to its skilled home health care program, increasing the expenditure cap for in-home and community-based services from 65% to 100% of the cost of comparable care in a VA Community Living Center.
This change supports Veterans with spinal cord injuries, ALS, and other complex medical conditions, significantly reducing out-of-pocket costs and expanding access to services such as home health aides, respite care, adult day health care, Veteran Directed Care, and skilled home health.
Effective under the Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act of 2025, the policy is expected to benefit approximately 200 Veterans in FY 2026, reinforcing VA’s commitment to value-based, home-centered care that promotes independence and better outcomes.
https://lnkd.in/efSxiAJN
#VeteransHealth #ManagedCare #HomeHealth #CommunityBasedCare #ValueBasedCare #HealthcarePolicy
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CMS National Audit Update – Medicare Advantage \(Part C IPM\)CMS will conduct a Part C Improper Payment Measure \(IPM\) audit to validate the accuracy of risk-adjusted Medicare Advantage payments for the 2024 benefit year.
🔍 What providers should know:
\* Applies to Florida Blue BlueMedicare HMO & PPO members
\* Review period includes dates of service from Jan. 1 – Dec. 31, 2023
\* CMS will assess medical record accuracy and completeness
\* Providers may be asked to submit medical records for selected patients
\* HIPAA authorizations are not required for this audit
Timely and accurate documentation remains critical to ensure compliance and appropriate reimbursement.
📧 Questions can be directed to: RPMChartProcurement\@FloridaBlue.com
Disclaimer: The CMS audit will include multiple Medicare Advantage payers, not just FL Blue. If you receive a request for records from a third party, it best practice to validate the requestor with the insurance plan. There are many bad actors taking advantage of these types of opportunities.
#MedicareAdvantage #CMSAudit #RiskAdjustment #ProviderCompliance #ManagedCare #HealthcareAdministration
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We’ve Jumped on the AI Trend!At @Managed Care Consultants of America, we decided to have a little fun and turn our team into AI caricatures — and let’s just say… the results are spot on 😄
We love blending innovation with personality — because while we take compliance, billing, and consulting seriously… we also know how to have a little fun as a team.
Let the guessing game begin! 🎭
Now it’s your turn! 👀
Can you guess who’s who? Drop your guesses in the comments below ⬇️
The below are all pictured can you guess who is who?
@[Alana Hanson-Williams, BSW](urn:li:person:Phufs6eVo3), @[Tabitha Faulk, BSN](urn:li:person:-m2UCc5eFB), @[Melanie Paulk](urn:li:person:BkEEJ4mbu1),
@[Christopher Langebrake](urn:li:person:XizlKgIoBj), @[Destiny Quinones, BSW, CEO](urn:li:person:bf2g6WOE44), @[Jeanine Rockett-Deveney, LPN,FAACM,MHCC-C](urn:li:person:OjDjVXXzu5), @[Nanette Johnson-Smith](urn:li:person:ffNTuFa6iz), @[Nikole Blackman, BSW](urn:li:person:0SAscLjfgW)
#ManagedConsultantsOfAmerica #HealthcareConsulting #AITrend #TeamSpotlight #GuessWho #HealthcareLeaders #SeniorCare #PostAcuteCare #InnovationInHealthcare #LinkedInFun #TrendingNow
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Texas Providers: Important Payment & EOP Update from Wellpoint Texas \(Effective Mid-January 2026\)@Wellpoint Texas is transitioning to expanded electronic payment and remittance options for providers serving Medicare Advantage and Medicaid members, beginning mid-January 2026.
🔹 Electronic Funds Transfer \(EFT\) remains the fastest and most secure payment method and connects directly to 835 ERAs for easier reconciliation
🔹 Providers not enrolled in EFT may receive virtual credit card \(VCC\) payments instead of paper checks \(processing fees may apply\)
🔹 Enrolling in EFT automatically opts providers out of VCC payments
🔹 Paper Explanation of Payment \(EOP\) and VCCs will no longer be mailed to providers using Availity Essentials
🔹 Digital ERAs and EOPs can be accessed anytime through Availity Remit Viewer
🔹 Providers not using Availity Essentials will continue to receive paper VCCs and EOPs
These updates are part of Wellpoint Texas’ ongoing efforts to reduce administrative burden and streamline reimbursement for provider partners across the state.
Texas providers should review their payment preferences and @Availity access ahead of the mid-January transition.
#WellpointTexas #TexasProviders #ProviderUpdates #ElectronicPayments #EFT #RevenueCycle #MedicareAdvantage #Medicaid #ManagedCare #MCCA
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Part 33: Joke of the weekBought new camera last weekend but it’s having a hard time staying together….
it’s really a loose Cannon
#Linkedinjokes #Jokeoftheweek #Jokes #Networking #PAC #PostAcuteCare
#Consulting #Consultants
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@BayCare Health System Medicare Advantage – Prior Authorization UpdateBayCare Plus has announced an updated timeline for its expanded Prior Authorization \(PA\) program to support a smooth transition for providers and members.
No PA changes will take effect until March 1, 2026
The delay allows time for provider education, system readiness, and aligned workflows
A new PA platform will enable instant authorization for medically necessary services that meet criteria
Expedited approvals remain in place for select services until go-live
Provider training materials begin rolling out the week of January 26, 2026
Providers should continue following current PA processes until March 1 and watch for additional guidance ahead of implementation.
A thoughtful approach focused on minimizing provider abrasion and member impact.
#ManagedCare #MedicareAdvantage #PriorAuthorization #ProviderUpdates #HealthcareAdministration #MCCA
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We’re grateful for the opportunity to be part of a meaningful 3-day tour with our very own @Tabitha Faulk, BSN](urn:li:person:-m2UCc5eFB) and @[US Family Health Plan- A TRICARE Prime option, visiting and connecting with our skilled nursing facility partners.This tour was all about collaboration, appreciation, and strengthening relationships across the continuum of care. A heartfelt thank you to @[Dusty Dolnik](urn:li:person:Oc5ewi0PFE), @[Vanessa Melancon](urn:li:person:nQUYlZ1rth), and Bryan Thompson for your time, partnership, and commitment to supporting SNF providers every step of the way.
At Managed Care Consultants of America, we value opportunities like these to engage directly with providers, say thank you, and continue working together to improve outcomes for the residents and communities we serve.
Looking forward to continued collaboration and many more conversations ahead!
#ManagedCareConsultantsOfAmerica #USFHP #SNFPartners #HealthcareCollaboration #Grateful #StrongerTogether
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Congratulations to @Avante Group Inc. on the Grand Opening of your Orlando location! What an incredible celebration highlighting not only your beautifully renovated facility, but also the heart and dedication of your team. It was inspiring to see so many well-deserved awards presented and to recognize the outstanding staff who went above and beyond—especially those who were on site during the emergency evacuation. Your commitment to resident care and safety truly shines.
Thank you for welcoming Managed Care Consultants of America and allowing us to be part of such a special milestone. We wish you continued success and look forward to all that’s ahead for Avante Orlando!
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Today we honor the life and legacy of Dr. Martin Luther King Jr. — a leader whose courage, compassion, and commitment to equality continue to inspire generations.At Managed Care Consultants of America, we believe in serving others with integrity, empathy, and purpose. Dr. King’s vision reminds us that progress is built through unity, respect, and meaningful action. His words challenge us to lead with heart, stand for what is right, and create opportunities that uplift those around us.
As we reflect today, may we each find ways—big or small—to serve, support, and strengthen our communities.
“Life’s most persistent and urgent question is, ‘What are you doing for others?’”
— Dr. Martin Luther King Jr.
#MLKDay #Leadership #Service #Community #ManagedCare #PurposeDriven
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Have you heard @CarePlus Health Plans has transitioned to Availity?CarePlus is transitioning the authorization process effective January 1, 2026.
Authorizations will now be requested via Availity or by faxing clinicals.
Case Management will now be handled by Humana's One Home team once authorization is approved.
Starting 2/1/2026 the One Home team will transition to the Anna portal where you can communicate the case management via the platform, and upload clinicals. Please note authorizations will still need to be requested via Availity.
View CarePlus' update's by clicking the link below:
https://lnkd.in/etPE-cX7
Have you encountered any challenges with CarePlus lately?
#CarePlus #ManagedCare #OneHome #MedicareAdvantage #CaseManagement
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Happy New Year from Managed Care Consultants of America! As we step into the new year, we reflect with gratitude on the partnerships, trust, and collaboration that made the past year so meaningful. We are thankful for our clients, partners, and healthcare leaders who continue to inspire excellence and innovation in everything they do.
The new year brings fresh opportunities, new goals, and continued growth. We look forward to supporting you with expertise, integrity, and dedication as we navigate the evolving healthcare landscape together.
Wishing you a successful, healthy, and prosperous year ahead!
🥂✨ #HappyNewYear #NewYearNewGoals #ManagedCare #HealthcareExcellence #ManagedCareConsultantsOfAmerica
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