Reminder for Providers: Oscar Health Prior Authorization Transition ApproachingA reminder that @Oscar Health officially transitioned on June 15, 2026 to @Availity Essentials™ for prior authorization submissions.
Providers who have not yet prepared should take action now to avoid delays and interruptions when the Oscar Provider Portal closes for new authorization requests later this summer.
✅ Existing Availity users: Add Oscar to your payer list
✅ Inactive accounts: Recover and reactivate credentials
✅ No Availity account: Register and assign your administrator
This transition is designed to improve workflow efficiency with:
✔️ Real-time authorization determinations
✔️ Electronic status tracking
✔️ Centralized authorization management
We at Managed Care Consultants of America encourages healthcare organizations, billing teams, and authorization staff to complete setup and training early to ensure a smooth transition.
#ProviderReminder #OscarHealth #Availity #PriorAuthorization
#ManagedCare #RevenueCycleManagement #HealthcareOperations
#MedicalBilling #HealthcareAdministration #PracticeManagement
#ProviderSupport
https://lnkd.in/ekEd2nUu
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⏰ Reminder for Providers: @Oscar Health Prior Authorization Transition Approaching ⏰A reminder that beginning June 15, 2026, Oscar Health will officially begin transitioning prior authorization submissions to Availity Essentials™.
Providers who have not yet prepared should take action now to avoid delays and interruptions when the Oscar Provider Portal closes for new authorization requests later this summer.
✅ Existing Availity users: Add Oscar to your payer list
✅ Inactive accounts: Recover and reactivate credentials
✅ No Availity account: Register and assign your administrator
This transition is designed to improve workflow efficiency with:
✔️ Real-time authorization determinations
✔️ Electronic status tracking
✔️ Centralized authorization management
We at @Managed Care Consultants of America encourages healthcare organizations, billing teams, and authorization staff to complete setup and training early to ensure a smooth transition.
#ProviderReminder #OscarHealth #Availity #PriorAuthorization #ManagedCare #RevenueCycleManagement #HealthcareOperations #MedicalBilling #HealthcareAdministration #PracticeManagement #ProviderSupport
https://lnkd.in/ekEd2nUu
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We’re honored to have been part of such an inspiring day!A heartfelt thank you to @TLC Management for inviting us to participate in your Golden Senior Olympics event. It was a privilege for our team to play a role in the festivities and witness the incredible determination, sportsmanship, and joy displayed by all of the athletes.
Events like these remind us of the power of inclusion, community, and celebrating every individual’s unique abilities. We are grateful for the opportunity to support such a meaningful event and connect with so many amazing participants, families, staff, and volunteers.
Thank you, TLC Management, for your dedication to creating memorable experiences and for allowing us to be a part of this special day. We look forward to future opportunities to celebrate and support your wonderful community!
#ManagedCareConsultantsOfAmerica #SpecialOlympics #CommunityPartnership #InclusionMatters #HealthcareLeadership #MakingADifference #Teamwork #MCCA #CommunityEngagement #ThankYouTLCManagement
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🚨 Provider Alert: Oscar Health Prior Authorization Transition to Availity Essentials™ 🚨Beginning June 15, 2026, Oscar Health will transition all prior authorization functions from the Oscar Provider Portal to Availity Essentials™. Providers should begin preparing now to avoid workflow disruptions during the summer 2026 rollout.
🔹 Key Dates to Know:
✅ June 15, 2026 – Prior authorization submissions open in Availity
✅ Summer 2026 – Oscar Provider Portal will no longer accept new authorization requests
What Providers Need to Do:
• Existing Availity users: Add Oscar to your payer list
• Inactive users: Recover credentials and reactivate accounts
• New users: Register and assign an administrator as soon as possible
🔹 Benefits of the Transition:
✔️ Real-time authorization determinations for many requests
✔️ Digital tracking and status monitoring
✔️ Centralized authorization management in one platform
Oscar and Availity will also provide:
📌 Step-by-step workflow guides
📌 Live webinar training sessions
📌 On-demand video resources
Managed Care Consultants encourages providers and office staff to prepare early to ensure uninterrupted authorization workflows and minimize delays in patient care.
#ManagedCare #PriorAuthorization #OscarHealth #Availity #HealthcareAdministration #MedicalBilling #RevenueCycleManagement #HealthcareProviders #PracticeManagement #UtilizationManagement #HealthcareOperations #ProviderAlert
https://lnkd.in/ekEd2nUu
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This Memorial Day, we pause to honor and remember the brave men and women who made the ultimate sacrifice in service to our country.At @Managed Care Consultants of America, we are deeply grateful for the courage, dedication, and selflessness of those who gave everything to protect the freedoms we enjoy every day. We also extend our heartfelt appreciation to the families who carry their loved ones’ legacies with strength and pride.
Today we remember. Today we honor. 🇺🇸
Wishing everyone a safe and meaningful Memorial Day.
#MemorialDay #HonorAndRemember #RememberAndHonor #ManagedConsultantsOfAmerica #HealthcareLeadership #Gratitude #ServingThoseWhoServe
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Finally had the opportunity to bring the Central Region’s Admissions and Marketing Team together this week, and it was definitely long over due!Loved being surrounded by exceptional individuals that have a great talent and passion for what they do everyday.
A special shoutout to @Nikole Blackman, BSW](urn:li:person:0SAscLjfgW) with @[Managed Care Consultants of America for coming out and providing us with great information regarding managed care products.
This week was a great reminder that what we do has purpose, impact, and value!
"The strength of the team is each individual member. The strength of each member is the team." — Phil Jackson
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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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