Medica Health Plan Solutions
Medica Health Plan Solutions is a third-party administrator (TPA) operating in Florida and Georgia. For an ASC, what matters isn't the logo. It's how Medica Health Plan Solutions pays: where it runs rich, where it runs thin, and how its reimbursement compares with peer plans for the same procedures.
Pilot Analysis
Get the complete Medica Health Plan Solutions analysis
Tell us where to send it. Our team will prepare an analysis of Medica Health Plan Solutions covering rates by code, market position, and underpaid areas, and email it to you within 5-10 business days. Need it faster? Book a demo.
What Insights reveals
How Medica Health Plan Solutions pays
See how Medica Health Plan Solutions reimburses across procedures and markets, benchmarked against the peer plans competing for the same cases. Not a raw rate sheet, a read on where it sits.
Geographic footprint
Medica Health Plan Solutions's presence spans Florida and Georgia. See where it concentrates and how that shapes the markets you compete in.
Peer position
Put your own position next to the benchmark for Medica Health Plan Solutions and bring the gap to your next contract conversation.
Specialty mix
Understand which procedures and specialties drive Medica Health Plan Solutions's volume, so you know where a rate change moves the needle.
Whether you're an ASC benchmarking a contract or a provider team looking Medica Health Plan Solutions up, DataLily AI maps how it reimburses across procedures and markets, and where your own rates sit against the peer benchmark.
Reference
Working with Medica Health Plan Solutions
- Payer ID
- 88090 is the EDI identifier used to route electronic eligibility checks (270/271), claim-status inquiries (276/277), and claims to Medica Health Plan Solutions through a clearinghouse.
- Eligibility verification
- Coverage and benefits for Medica Health Plan Solutions members are verified before the date of service, through a clearinghouse using payer ID 88090or through the payer's provider portal.
- Prior authorization
- Requirements are set per plan and per procedure. Confirm whether an authorization is required with Medica Health Plan Solutions directly before the date of service.
Book a demo: pick a time
A 15-minute walkthrough of Medica Health Plan Solutions the way it pays.
- What is Medica Health Plan Solutions's payer ID?
- Medica Health Plan Solutions's electronic payer ID is 88090. ASC billing teams use it to route eligibility checks (270/271), claim-status inquiries (276/277), and electronic claims to Medica Health Plan Solutions through a clearinghouse.
- How do ASCs verify eligibility for Medica Health Plan Solutions members?
- Eligibility and benefits for Medica Health Plan Solutions members are verified before the date of service, either electronically through a clearinghouse (a 270/271 transaction using payer ID 88090) or through the payer's provider portal.
- Does Medica Health Plan Solutions require prior authorization for ASC procedures?
- Prior-authorization requirements for Medica Health Plan Solutions are set per plan and per procedure. Confirm whether an authorization is required with Medica Health Plan Solutions directly before the date of service.
- What type of payer is Medica Health Plan Solutions?
- Medica Health Plan Solutions is a third-party administrator (TPA) operating in Florida and Georgia.
- How does Medica Health Plan Solutions compare with other payers for ASC procedures?
- Ask Rose and you get a plain-language read on where Medica Health Plan Solutions pays above or below peer plans for your top procedures, charted, and ending in a recommendation you can take into a contract conversation.
- Is Medica Health Plan Solutions paying my ASC below market?
- Put your own Medica Health Plan Solutions contract next to the peer benchmark in DataLily AI and you'll see the gap by procedure and market, the fastest way to know whether you're leaving money on the table.