Fall SNF Newsletter

October 2026

Managed Care Updates & Important Provider Reminders

Managed Care Consultants of America (MCCA) is committed to keeping providers informed of important payer updates, authorization requirements, claims processes, and resources that impact daily operations. Review the updates below and share them with the appropriate members of your team.

Aetna Claims Updates: Medical Attachments Dashboard

This applies to all states

Effective August 7, 2026

Aetna has introduced digital updates designed to improve claims visibility and help providers submit requested documentation more efficiently.

What's Changing?

Electronic remittance advice (ERA) may identify claims requiring additional documentation and provide more detailed remark-code messages.
The new Medical Attachments Dashboard in Availity allows providers to view claims requiring additional information and submit up to 10 attachments, with each file up to 64 MB.
In Claim Status Inquiry, category codes P3 and P4 change to F2 when additional information is needed.
The 277P transaction is no longer available.

What Providers Need to Do

Review ERA messages regularly and submit requested documentation through the Medical Attachments Dashboard in Availity. Do not use appeals forms or dispute addresses to submit requested documents, as doing so may delay claims processing.

For dashboard training, log in to Availity, navigate to Help & Training, select Get Trained, and search for “Attachments Dashboard.”

WellMed Prior Authorization Transition to Curo

This applies to Florida

Required Beginning November 1, 2026

WellMed is transitioning prior authorization requests and notifications to the Curo Provider Authorization portal through ePRG.

Beginning November 1, 2026, all WellMed prior authorization requests and notifications must be submitted through Curo via ePRG. Fax submissions will no longer be accepted, except where required by law.

Action Items for Providers

Register for ePRG and begin familiarizing your team with the portal.
Review the ePRG Quick Guide and complete the appropriate provider training.
Use Curo to submit authorization requests, upload supporting clinical documentation, track request status, and manage authorization updates.
Monitor electronic notifications for approvals, requests for additional information, denials, and peer-to-peer opportunities.

Don't wait until the transition date! Prepare your authorization team now to help prevent submission delays and interruptions.

Centene: Updated Level Definitions

This applies to all states

Centene periodically updates its level definitions. Providers should review the latest information to understand the applicable level criteria and ensure their teams are working from the most current guidance.

What Providers Should Do:

Review the updated level definitions available through the MCCA client portal.
Share the updated information with your Director of Nursing, Director of Rehabilitation, and other team members involved in clinical documentation and level-of-care reviews.
Ensure supporting documentation reflects the member's clinical needs and the applicable level criteria when submitting authorization requests or reviews.

Access the Latest Information

Click the link below to review the most current Centene level definitions and related provider resources.

Please note this applies to these plans: This applies to Absolute, Ambetter, Fedelis Care, Meridian, Nebraska Total Care, PA Health & Wellness, Superior, and Wellcare.

View the Centene document here

CMS Updates: Interoperability & Prior Authorization Requirements

CMS Prior Authorization Updates: What Providers Need to Know

CMS finalized Rule CMS-0057-F to improve health information sharing and streamline prior authorization processes for impacted Medicare Advantage, Medicaid, CHIP, and certain Qualified Health Plans.

Key Updates:

Decision timeframes: Generally, 72 hours for expedited requests and seven calendar days for standard requests.
Denial transparency: Beginning in 2026, impacted payers must provide specific reasons for prior authorization denials.
Electronic authorization: New API requirements beginning in 2027 will support electronic submissions, documentation requirements, and status updates.

Provider Reminder: Monitor payer communications for changes to authorization procedures and documentation requirements to help prevent delays.

View the full article here

Florida Medicaid Open Enrollment Is Now Open!

This applies to Florida

Florida Medicaid managed care open enrollment is underway. During the annual 60-day open enrollment period, members can make changes to their health plans. Changes are generally limited to annual open enrollment or state-approved “for cause” reasons.

Providers should verify members’ current Medicaid plan enrollment and benefits to help prevent authorization, coverage, and billing issues.

View the Official Florida Medicaid Open Enrollment Schedule

Medicare Open Enrollment Is Here!

This applies to all states

Medicare Open Enrollment is underway! During this annual enrollment period, Medicare-eligible individuals can review their coverage and make changes to better meet their healthcare needs.

During Open Enrollment, beneficiaries can:

Switch from Original Medicare to a Medicare Advantage plan.
Change from one Medicare Advantage plan to another.
Change their stand-alone Medicare Part D prescription drug plan.

Provider Reminder: Open Enrollment is a great time to remind patients and residents to review their coverage for the upcoming year. Changes in plan enrollment may affect network participation, benefits, and prior authorization requirements.

Open Enrollment happens every year! Encourage beneficiaries to review their options before the December 7 deadline.

View the official Medicare open Enrollment Schedule