Dear valued subscribers,

We are thrilled to introduce MCCA's first Home Care centered newsletter. As our company continues to grow and evolve, we recognized the need for a dedicated newsletter that focuses specifically on the Home Care industry. 

We understand the importance of staying informed and connected in today's ever-changing healthcare landscape, and we believe that this newsletter will be a valuable resource for anyone involved in the Home Care industry.

Thank you for your continued support and interest in MCCA's mission to improve the quality of care for all individuals. We hope you enjoy reading our first Home Care centered newsletter.

Best regards,

The MCCA Team


Carelon Important Billing Reminders- Aetna Medicare

Carelon provides authorization for skilled services, Home Health Aides & MSW's for Aetna Medicare patients in Florida. LPN & assistant visits are included in those authorizations. The agency is responsible for assigning the appropriate clinician for the service.

Your billing team then submits the correct HCPC code based on who performed the services.Any questions please contact your MCCA liaison.

Effective January 1, 2024, all Carelon claims will be submitted through Availity. Carelon's payer ID will stay the same. After January 1st you will not be able to submit paper claims. You can still use your clearinghouse, but they will need to connect to Availity's EDI gateway, or you can submit directly through Availity and not use a third-party.

Carelon also sent a reminder that date changes are not necessary for visits completed within a certification period. The authorized visits can be used whenever during the certification period.

Carelon Provider Resources

Carecentrix Non-routine supplies and Prior Authorization

A friendly reminder regarding routine & non-routine supplies: review your contracts for the reimbursement rate of non-routine supplies. Non-routine supplies are defined as necessary treatment of specific patients. If they are specifically ordered by a physician or are essential to effectuate the plan of care, are not considered routine supplies. Per the agreement, if routine supplies are utilized in greater quantities, they may be billed as payable non-routine supplies, when medically necessary and you have received authorization.

Registration/ Pre-notification is required for all services arranged through CareCentrix. Prior authorization is only required for certain codes.

Please make sure you visit the CareCentrix or MCCA portal to review the prior authorization tool.

Carecentrix is hosting a webinar to keep you up to date. Information can be found on the CareCentrix home page under News Flash.


Positive Health Plan Notice

Positive Health Plan announced that their PHP Medicare Advantage plan will cease operations in 2024. PHP will continue to process claims with dates of service through December 31, 2023.

PHP currently provides Medicare benefits in Broward, Duval & Miami-Dade Counties.

If you have a provider service agreement with their Aids Healthcare foundation, you will not need to term the agreement as that line of business is not leaving.

Plan Closure Notice

One Home Care

Effective November 1, 2023, One Home Care will be facilitating the authorizations for Humana Conviva Primary Care & Humana CenterWell Primary Care in certain counties. One Home will manage the members eligibility, authorizations and the claims. If your agency falls into the counties, MCCA has either reached out to you for approval or completed the credentialing to move forward with contracts.

If you have any questions, please contact Regina Wild at rwild@mccofamerica.com

One Home Care

Updates/News from Managed Care Consultants of America

If you have not enrolled in the MCCA portal, we strongly encourage you to do so. Copies of your current contracts, grids & additional resources are all at your finger tips. We strive to make accepting managed care patients an easier process. If you need assistance, please reach out to Regina Wild.

Visit Our Portal

MCCA Portal Instructions


Are you planning on attending HCAF's CEO Executive Retreat December 12-13 at the Marriot Orlando Airport Lakeside?

If so, make sure you stop by and see us. Better yet, let us know ahead of time so that we can make plans to meet. We hope to see you there.

HCAF CEO Strategy Retreat

Please verify benefits & eligibility monthly!