Medica Q&A

There is no change to the Prevea360 Health Plan name. The Dean Health Plan logo was updated to include a “by Medica” endorser and heart icon.

We do not foresee changes in business locations. Both health plans remain committed to serving their communities through close partnerships with local health care providers.

We encourage providers to reach out to Medica through their usual channels with any questions about their Medica contracts.

Effective Jan. 1, 2023, Prevea360 Health Plan launched a new State of Wisconsin Employee Trust Fund (ETF) product for State of Wisconsin employees and their families. The State of WI ETF – Prevea360 West and Mayo Clinic Health System provider network serves this member population.

Mayo Clinic Health System locations in this network are accessible through the Health Plan’s partnership with Medica. (Non-ETF enrollees assigned to the Prevea360 West provider network do not have access to Mayo Clinic Health System facilities and providers.)

Prevea360 Health Plan’s policies, prior authorization requirements, and claim submission processes apply for the State of Wisconsin ETF patient population. See our provider manual for more information on this product.

Yes, for some benefit plans. We’ve moved our 2024 Individual + Family Business (IFB)/Affordable Care Act (ACA) plans (both Marketplace and direct) and are transitioning Commercial plans (as groups renew) to new business platforms under payer ID 41822. As we communicated early in our partnership with Medica, both health plans anticipated using the partnership as an opportunity to align best practices and share technology.

Prevea360 Health Plan shares the following business platforms and systems with Medica for benefit plans under the payer ID 41822:

• Availity Essentials Provider Portal
• Availity Electronic Data Interchange (EDI) Gateway
• InstaMed payment services (remittance advice, Explanations of Payments, electronic funds transfer [EFT], and paper checks)
• New Provider Service phone number featuring expanded hours, and 24/7 self-service through the Interactive Voice Response (IVR) system

Currently, the above platforms apply to benefit plans under payer ID 41822* which are:

• IFB/ACA plans for dates of service on and after Jan. 1, 2024.
• Commercial plans in phases as groups renew, with the first renewals Jan. 1, 2025.

Business platforms for all other payer IDs remain the same until further notice.

*Except for InstaMed which also applies to payer ID 39113.

We’ll announce dates to move additional benefit plans to business platforms under payer ID 41822 in the future.

Continue to use the Prevea360 Health Plan website for online information.* See the following resources under the “Our Medica partnership” section of the Provider Communications web page:

• Prevea360 Health Plan Provider Quick Reference by Payer ID – Identifies resources and processes with the addition of payer ID 41822.
• Prevea360 Health Plan’s Just in Time for Providers – Latest information on preparation and processes as we transition to business platforms under payer ID 41822.
• Provider Communications – a list of communications about our partnership with Medica.

* As we align business platforms and policies with our partner Medica, Prevea360 Health Plan providers should continue referring to Prevea360.com for information.

Refer to this FAQ web page for updates. Also, go to our Provider News and Provider communications web pages to see articles and communications regarding our partnership with Medica.

No, there is no change to the patients you can serve. You can only deliver care to patients enrolled in benefit plans covered under your provider contract with us.

If you have questions, contact your Provider Network Consultant. To find your assigned consultant, go to Prevea360.com/providers and scroll to the bottom of the web page.