Attention Florida Medicaid Providers:A major shift is coming to Florida’s Children’s Medical Services \(CMS\) Plan—and providers should start preparing now.
Effective October 1, 2026, the Florida's Children's Medical Services Plan \(CMS Plan\) will transition from @Sunshine Health to @Molina Healthcare of Florida, making Molina the sole statewide plan administrator for this population.
What this means for providers:
• Participation in the CMS Plan will require contracting with Molina
• Current members will be automatically transitioned, with opt-out options available
• A Continuity of Care period \(up to 8 months\) will allow patients to continue seeing current providers through May 31, 2027 \(or until care plans are updated\)
• Existing authorizations, prescriptions, and appointments must be honored during the transition
Molina is actively contracting and prioritizing providers who support continuity of care—making this a critical window to evaluate participation, contracts, and network alignment.
For provider groups, this transition is more than administrative—it’s an opportunity to reassess payer strategy, ensure contract readiness, and explore potential rate and term negotiations.
#ManagedCare #FloridaMedicaid #HealthcarePolicy #ProviderNetworks #ContinuityOfCare #PayerContracting #HealthcareOperations #MedicaidManagedCare
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Attention @UnitedHealthcare providers:A recent claims processing issue is impacting providers—and timely action is critical.
Claims rejected on April 7–8, 2026, with 277CA status code 12 \(member pick/member mismatch\) were affected by a system error that has now been resolved. Providers should take a moment to review and ensure any impacted claims are resubmitted for processing.
Key reminders:
• Resubmit affected claims using your standard submission process
• Do not mark them as corrected claims
• Timely filing requirements still apply
• If already resubmitted—no further action is needed
This is a good reminder of how quickly system issues can disrupt revenue cycles—and the importance of monitoring rejections closely to avoid unnecessary delays.
https://lnkd.in/euWsvN2e
#ManagedCare #RevenueCycleManagement #ClaimsProcessing #HealthcareOperations #ProviderAlert #MedicalBilling #HealthcareCompliance
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VA Community Care Recovery Audits UnderwayThe VA is initiating recovery audits for community care claims submitted between 2024–2029, in alignment with the Payment Integrity Information Act of 2019.
🔍 What Providers Should Know:
• Audits will review inpatient, outpatient, and skilled nursing facility claims
• Reviews will be conducted by Cotiviti and Machinify on behalf of the VA
• Certain claims are excluded, including beneficiary-paid claims and select pharmacy services
• The VA Financial Services Center will manage any confirmed overpayment recoveries
🔄 Provider Options:
Providers will have the opportunity to request reconsideration of audit findings or establish repayment plans if needed
📌 As audit activity increases, it’s critical for providers to ensure documentation accuracy, billing compliance, and audit readiness.
https://lnkd.in/gWEuswV7
#ManagedCare #VAAudits #HealthcareCompliance #PaymentIntegrity #RevenueCycle #AuditReadiness #HealthcareOperations #SkilledNursing #ProviderEducation #HealthcareLeadership
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Attention Home Health providers:@Integrated Home Care Services, Inc. is tightening up its authorization process—and email submission is officially out.
Due to process complexity and compliance risk, Integrated Home Care Services \(IHCS\) will no longer accept authorization requests via email, effective immediately. This applies to both new and concurrent requests.
Here’s what providers need to know:
• Initial authorization requests → must be submitted via fax \(844-215-4265\)
• Concurrent requests → must be submitted through the IHCS MedTrac portal
For organizations supporting DME, Home Health, and Infusion services, this shift underscores the ongoing push toward standardized workflows and reduced audit risk. Ensuring your teams are aligned with updated submission protocols is key to avoiding delays in care and reimbursement.
For questions, IHCS support remains available at \(844\) 215-4264.
#ManagedCare #HealthcareOperations #UtilizationManagement #HomeHealth #DME #InfusionServices #HealthcareCompliance #ProviderAlert #CareCoordination
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We’re excited to share that Managed Care Consultants of America will be attending @The South Carolina Health Care Association Annual Conference from April 26–29! 📍 Stop by Booth #303 to connect with our team and learn how we continue to support providers with expert managed care solutions.
Be sure to say hello to our very own @[Tabitha Faulk, BSN](urn:li:person:-m2UCc5eFB) and @[Jeanine Rockett-Deveney, LPN,FAACM,MHCC-C](urn:li:person:OjDjVXXzu5), who will be there and ready to meet, network, and answer any questions!
We look forward to seeing familiar faces and making new connections—see you there!
#ManagedCare #HealthcareLeadership #SCHCA #LongTermCare #HealthcareConference #Networking #MCCA
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Provider Directory Compliance Alert – Q2 2026 Attestation RequiredProviders contracted with major health plans must complete their Q2 2026 provider directory attestation to remain compliant with CMS regulations.
🔹 Action Required:
Register in Availity Essentials™ and attest to your data via the Provider Data Management \(PDM\) application
🔹 Who’s Impacted:
Providers contracted with plans including Aetna, Anthem, Cigna, Health Net, Molina, and others participating in the Symphony Provider Directory
🔹 Deadline:
June 30, 2026
⚠️ Non-Compliance Risks:
• Delayed payments or reimbursements
• Member reassignment to compliant providers
• Removal from health plan directories
Quarterly attestation ensures accurate provider data, regulatory compliance, and uninterrupted revenue cycle performance.
#ManagedCare #ProviderCompliance #CMS #HealthcareRegulations #RevenueCycle #Availity #ProviderDirectory #HealthcareOperations #PracticeManagement #HealthcareLeadership
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We had such a wonderful time at the @Waterman Village Retirement Community of Orlando - Central - Leesburg Florida Health Fair! Thank you to the entire team at Waterman Village for inviting Managed Care Consultants of America to be a part of this special event. It was a pleasure connecting with so many amazing individuals, sharing insights, and building meaningful relationships within the community.
We truly appreciate the opportunity and look forward to continuing to support and collaborate in the future!
#ManagedCareConsultants #HealthcareCommunity #Networking #Gratitude #HealthFair #StrongerTogether
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🚨 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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