Appointment Access and Office Wait Time: Acceptable time standards for patients making appointments and for wait times in the office.

Care Management: Information on the Health Pregnancy, Pediatric Case Managment, Transplant Case Management, Adult Case Management, Restricted Recipient and Medicare/Medicaid Specific Programs and Benefit Appeals.

Centers of Excellence: Information on this program and access to a list of approved providers.

Clinic Site Survey: Procedures for conducting a practitioner office site-related compaint survey.

HIPAA Business Associate Requirements for Providers: Detailed information for the Privacy Rule from the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Medical Policies: Find current versions of Medica utilization management (UM) policies, coverage policies, Institute for Clinical Systems Improvement (ICSI) guidelines, and Medica clinical guidelines.

Member Rights and Responsibilities: Outlines Medica members' legal rights and responsibilities. 

Medical Record Review: Examination and improvement of medical practice performance.

Provider Reporting Obligations: Find information and forms intended for Medica network providers to use in responding to reporting obligations required by law, contract or accreditation standards (including those required by the National Committee for Quality Assurance, or NCQA^®).

Provider Responsibilities: How Medica works with participating providers to maintain high-quality, cost-effective health care.

Quality Guidelines and Improvement: Encompasses a wide range of clinical and service quality initiatives. 



Return to Provider Administrative Manual.