Provider communications

For dates of service on and after Jan. 1, 2024, we’re moving Individual and Family business (IFB)/(Affordable Care Act) plans to the Availity Essentials Provider Portal under payer ID 41822. The authorization submission functionality in this portal is not yet available. To ensure that providers and their support teams can request prior authorizations while this function is being activated, follow the interim steps for one of the following submission options for dates of service on and after Jan. 1, 2024:

Option 1: Submit an electronic prior authorization form from the Medica provider portal:

1. Sign in to your Medica (formerly WellFirst Health) Provider Portal account, select the Authorization Submission Payer ID 41822 tile from Provider Portal homepage.
2. Click “Inpatient and Outpatient Services” at the top of the page.
3. Complete all fields on the form and click Submit. A message confirming receipt is sent. Note: The form must be completed and submitted within a single session as it cannot be saved and returned to for a future submission.
4. Submit the supporting documentation via one of the following ways:
   • Fax 1-608-252-0830; or
   • Email: ifbhealthmanagement@medica.com. For emailed supporting documentation, an acknowledgement is sent to the submitter’s email address.

Option 2: Fax or email prior authorization form from our website:

1. Go to the Medical Management page and select the appropriate form under the “Prior Authorization Forms” section. Note: The new “General” form is for Outpatient and Inpatient requests.
2. Complete all fields on the form. Note: Forms have been updated with added fields for information that will help facilitate authorization reviews.
3. Submit the form and supporting documentation via:
   • Fax: 1-608-252-0830; or
   • Email: ifbhealthmanagement@medica.com. For emailed requests, an acknowledgement is sent to the submitter’s email address.
4. To inquire about an authorization status, call customer care at 800-458-5512 once the processing timeframe has elapsed. All authorizations are processed in adherence to state and other regulatory turnaround times which can vary based on the authorization type and/or state in which the service will be provided. Please refer to the Medica (formerly WellFirst Health) Provider Manual for determination and notification timeframes applicable to your authorization request before calling customer care.
5. Receive authorization determinations (approved/denied) via fax, regardless of submission method, to the fax number that was entered on the authorization form. (Please monitor the return fax number for the determination.) All authorization determinations are mailed to the member, regardless of submission method.
6. If necessary, fax or email authorization updates and cancellations using one of the methods listed in step 3.

See Medica’s Just in Time for Providers (PDF) on how to obtain authorization status and determinations, and make updates to or cancel authorization requests.

Remember, Availity Essentials will only be for IFB business initially. You must retain your accounts in the Medica (formerly WellFirst Health) Provider Portal for all other products under payer ID 39113.

See communications about our partnership with Medica, changes to business platforms, and new processes in the provider communications linked below.

• February 2024 Provider News – Learn why payer ID is so important.
• January 12th, 2024 Provider Information – Are you using the correct resources for your patients?
• January 2024 Provider News – Processes and resources for new payer ID 41822.
• December 2023 Provider News – Preparing to move to new, long-term business platforms for IFB plans, including webinars featuring the new provider portal.
• November 2023 Provider News – Learn more about Availity Essentials provider portal applications and InstaMed payment services for 2024 IFB plans.
• Fall 2023 Provider News cover story (PDF) – Announcing Availity as our new electronic data interchange (EDI) clearinghouse and provider portal vendor! Plus, new member ID cards and customer care phone numbers and technology.
• Summer 2023 Provider News cover story (PDF) – Changes coming for claims processing and resources: What you need to know
• Spring 2023 Provider News cover story (PDF) – Pursuing innovations with a new partner.
• Growing with a New Partner – What to Expect in 2023 (PDF) – Find out what’s ahead as we partner with Medica to align best practices and share technology, including a new, shared claims processing platform.
• Medica Q&A – Who is Medica, what's changing and how to stay informed this year.