The Provider Service Center is the first point of contact for providers in regards to eligibility inquiries, benefit determination questions and claim status issues. Provider service representatives are available Monday through Thursday from 8:30 a.m. to 5 p.m., and Friday from 9 a.m. to 5 p.m.


Phone contact

Call: 1-800-458-5512 

Press 1 to reach the Provider Service Center, then choose from the following options:

• Press 1 for automated information on claims, benefits and elegibility
  
• Press 2 to speak with a representative regarding a member’s effective date, benefits or claims, then:
  1 to verify effective date or to get an ID number
  2 for benefit information
  3 for hospital and other UB-92 claims
  4 for physician claims
  5 for all other claims (ancillary and RAPLET)
  0 to repeat menu
  
• Press 3 for pharmacy inquiries, then:
  1 for MedImpact or MedCare, then: 
      1 for pharmacy related appeals
  2 for Medco
  3 all other inquiries 
  
• Press 4 for High-Tech Imaging consultations, administrative referrals, notification of inpatient admissions and medical services, case management or appeals, then:
  1 for administrative referrals
  2 for notification of inpatient admissions
  3 for notification of surgical or medical services
  4 for case management
  5 for appeals
  9 for High-Tech Imaging consultations
  0 to repeat menu 
  
• Press 5 to call another extension 
  
• Press 6 for other options, then:
  1 for technical support on Medica.com
  2 for the Medica claims address
  
• Press 0 to repeat the options

Provider service representatives can assist with the following inquiries and more:

• Member eligibility
• Member's benefit and product information
• Benefit eligibility and requirements
• Status of a claim or adjustment
• Claim reimbursement determinations and adjustments
• Participating provider ID numbers
• Claim processing procedures
• Electronic claim entry rejections
• Coordination of benefits as related to claim processing
• Referrals/authorizations
• Copayments, coinsurance and deductibles as related to claim processing
• Education and clarification regarding claims processing procedures and provider communications
• High-level inquiries regarding electronic submission of claims
• Assistance with provider demographic updates and changes
• Medica.com questions
• Appeals questions
• Automated Phone Response System

Return to Medica Points of Contact.