Payer Space: Medica

Medica is a fairly complex payer because of the large number of plan types compared to other payers. To manage the billing differences between these payers, in HCHB there are various Medica payers set up.

Plan types are differentiated by the group number or ID prefix, which can be found on the insurance eligibility run. Follow the table below to select the correct plan type.

It is very important to set up a client's payer in their chart under the correct Medica plan type. Failing to set up the correct payer will result the insurance denying our claim for payment.

🎯PLAN TYPES

Identify the correct Medica plan type by group number or ID prefix:

Use the group number or ID prefix listed on the insurance eligibility page to identify the type of plan. Click a plan name to jump to that specific section.

Group Number or ID Prefix	Plan Type
A _ _ _ or B _ _ _	Medica Mayo Premier Minnesota (Commercial)
A0061	Medica Medicare Advantage Solution FFS (Managed Medicare)
A00500	Medica ChoiceCare PMAP (Managed Medicaid) or Medica MinnesotaCare PMAP (Managed Medicaid)
05 *_ _ _*	Medica Accessibility Solutions (Managed Medicaid)
07_ _ _ or 08_ _ _	Medica Dual Solutions (MSHO: Managed Medicare and Medicaid Combined)
08977, 08978, or 08979	Medica Accessibility Solutions Enhanced - FFS (MSHO: Managed Medicare and Medicaid Combined)
59 _ _ _	Medica ChoiceCare MSC+ (Managed Medicaid)
70 _ _ _	Medica Medicare Prime Solutions - DO NOT BILL. This is a supplemental plan only (does not cover homecare).
TBD (Payer will be effective 10/01/2026)	Medica One Health Plan (Managed Medicaid)
5-6 digits Group number of 5-6 digits not matching any other category	Medica Commercial
C_____ Member Policy Number Prefix	Medica Individual Family Benefit (Commercial)

Medica Mayo Premier Minnesota (Commercial)

Group ID Number	Order Supplies via HCHB/Medline?	M0150 OASIS Response	Procedure Billing Codes (CPT Codes)
A _ _ _ or B _ _ _	No	8	T and S Codes

Group ID Number

Order Supplies via HCHB/Medline?

M0150 OASIS Response

Procedure Billing Codes (CPT Codes)

A _ _ _ or

B _ _ _

T and S Codes

✔️ Eligibility, Coverage, & Benefits

Run eligibility on Availity.com
Contact for benefits and eligibility information: 800-458-5512

🔨 Payer Setup

In HCHB, set up the payer as:
- Payer Source: MEDICA MAYO PREMIER MN
- Payer Type: COMMERCIAL INSURANCE

Medica Medicare Advantage Solution FFS (Managed Medicare)

Group ID Number	Order Supplies via HCHB/Medline?	M0150 OASIS Response	Procedure Billing Codes (CPT Codes)
A0061	No	2	G Codes

✔️ Eligibility, Coverage, & Benefits

Run eligibility on Availity.com
Contact for benefits and eligibility information: 800-458-5512
Client must be homebound to be eligible for payment.

🔨 Payer Setup

In HCHB, set up the payer as:
- Payer Source: MEDICA ADVANTAGE SOLUTION - MDCR
- Payer Type: MEDICARE ADVANTAGE - FFS

Medica ChoiceCare PMAP (Managed Medicaid) or Medica MinnesotaCare PMAP (Managed Medicaid)

Group ID Number	Order Supplies via HCHB/Medline?	M0150 OASIS Response	Procedure Billing Codes (CPT Codes)
A00500	No	4	T and S Codes

✔️ Eligibility, Coverage, & Benefits

Run eligibility on Availity.com
Contact for benefits and eligibility information: 800-458-5512
Medica MinnesotaCare Plan Details: https://www.medica.com/shop/medicaid/medica-minnesotacare
Medica ChoiceCare PMAP Plan Details: https://www.medica.com/shop/medicaid/medica-choicecare-pmap

🔨 Payer Setup

In HCHB, set up the payer as:
- Payer Source: MEDICA MINNESOTA CARE - PMAP
- Payer Type: MANAGED MEDICAID- PMAP

Medica Accessibility Solutions (Managed Medicaid)

Group ID Number	Order Supplies via HCHB/Medline?	M0150 OASIS Response	Procedure Billing Codes (CPT Codes)
05 _ _ _	No	4	T and S Codes

✔️ Eligibility, Coverage, & Benefits

Run eligibility on Availity.com
Contact for benefits and eligibility information: 800-458-5512

🔨 Payer Setup

In HCHB, set up the payer as:
- Payer Source: MEDICA - MSHO/PMAP
- Payer Type: MANAGED MEDICAID- PMAP
When adding authorization, use:
- Program Name: ACCESSIBILITY - INTERMITTENT

Medica Dual Solutions (MSHO: Managed Medicare and Medicaid Combined)

Group ID Number	Order Supplies via HCHB/Medline?	M0150 OASIS Response	Procedure Billing Codes (CPT Codes)
07_ _ _ or 08_ _ _	No	2 and/or 4	T and S Codes

Group ID Number

Order Supplies via HCHB/Medline?

M0150 OASIS Response

Procedure Billing Codes (CPT Codes)

07_ _ _ or

08_ _ _

2 and/or 4

T and S Codes

✔️ Eligibility, Coverage, & Benefits

Run eligibility on Availity.com
Contact for benefits and eligibility information: 800-458-5512

🔨 Payer Setup

In HCHB, set up the payer as:
- Payer Source: MEDICA - MSHO/PMAP
- Payer Type: MANAGED MEDICAID- PMAP
When adding authorization, use:
- Program Name: MSHO/DUAL - INTERMITTENT

Medica Accessibility Solutions Enhanced - FFS (MSHO: Managed Medicare and Medicaid Combined)

Group ID Number	Order Supplies via HCHB/Medline?	M0150 OASIS Response	Procedure Billing Codes (CPT Codes)
08977 or 08978 or 08979	No	2 and/or 4	T and S Codes

Group ID Number

Order Supplies via HCHB/Medline?

M0150 OASIS Response

Procedure Billing Codes (CPT Codes)

08977 or

08978 or

08979

2 and/or 4

T and S Codes

✔️ Eligibility, Coverage, & Benefits

Run eligibility on Availity.com
Contact for benefits and eligibility information: 800-458-5512

🔨 Payer Setup

In HCHB, set up the payer as:
- Payer Source: MEDICA - MSHO/PMAP
- Payer Type: MANAGED MEDICAID- PMAP
When adding authorization, use:
- Program Name: ACCESSIBILITY - INTERMITTENT

Medica ChoiceCare MSC+ (Managed Medicaid)

Group ID Number	Order Supplies via HCHB/Medline?	M0150 OASIS Response	Procedure Billing Codes (CPT Codes)
59 _ _ _	No	4	T and S Codes

✔️ Eligibility, Coverage, & Benefits

Run eligibility on Availity.com
Contact for benefits and eligibility information: 800-458-5512

🔨 Payer Setup

In HCHB, set up the payer as:
- Payer Source: MEDICA - MSHO/PMAP
- Payer Type: MANAGED MEDICAID- PMAP
When adding authorization, use:
- Program Name: PMAP - INTERMITTENT

Medica One Health Plan (Managed Medicaid)

Group ID Number	Order Supplies via HCHB/Medline?	M0150 OASIS Response	Procedure Billing Codes (CPT Codes)
Unknown as of 8/31/2026 - PAYER WILL BE EFFECTIVE 10/1/2026	No	4	T and S Codes

✔️ Eligibility, Coverage, & Benefits

Run eligibility on Availity.com
Contact for benefits and eligibility information: 800-458-5512

🔨 Payer Setup

In HCHB, set up the payer as:
- Payer Source: ?
- Payer Type: ?
When adding authorization, use:
- Program Name: ?

Medica Commercial

Group ID Number	Order Supplies via HCHB/Medline?	M0150 OASIS Response	Procedure Billing Codes (CPT Codes)
5-6 digits Group number of 5-6 digits not matching any other category	No	8	T and S Codes

Group ID Number

Order Supplies via HCHB/Medline?

M0150 OASIS Response

Procedure Billing Codes (CPT Codes)

5-6 digits

Group number of 5-6 digits not matching any other category

T and S Codes

✔️ Eligibility, Coverage, & Benefits

Run eligibility on Availity.com
Contact for benefits and eligibility information: 800-458-5512

🔨 Payer Setup

In HCHB, set up the payer as:
- Payer Source: MEDICA
- Payer Type: COMMERICAL INSURANCE

Medica Individual Family Benefit (Commercial)

Member ID Prefix	Order Supplies via HCHB/Medline?	M0150 OASIS Response	Procedure Billing Codes (CPT Codes)
C_____	No	8	T and S Codes

✔️ Eligibility, Coverage, & Benefits

Run eligibility on Availity.com
Contact for benefits and eligibility information: 800-458-5512

🔨 Payer Setup

In HCHB, set up the payer as:
- Payer Source: MEDICA IFB PLAN
- Payer Type: COMMERCIAL INSURANCE

APPENDIX

Procedure/Billing Codes (CPT Codes)

G Codes

Billing Code	Skill	Description
G0299	RN	Home health skilled nursing visit
G0300	LPN	Home health skilled nursing visit
G0151	PT	Home health physical therapy visit
G0157	PTA	Home health physical therapy assistant visit
G0152	OT	Home health occupational therapy visit
G0158	COTA	Home health certified occupational therapy assistant visit
G0155	MSW	Home health medical social work visit
G0156	HHA	Home health home health aide visit

T and S Codes

Billing Code	Skill	Description
T1030	RN	Home health skilled nursing visit
T1031	LPN	Home health skilled nursing visit
S9131	PT/PTA	Home health physical therapy visit
S9129	OT/COTA	Home health occupational therapy visit
S9128	SLP	Home health speech language pathologist visit
S9127	MSW	Home health medical social work visit
T1021	HHA	Home health home health aide visit
S5130	HMK	Home health homemaking hourly
T1004	HHA Hourly	Home health home health aide hourly

📅 Effective: 09.01.2026 | 🛠️ Revised: N/A | ✅ Approved: JFJ