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Benefit Appeals
Provider appeals on behalf of members for claims issues when denied as member liability. |
1-800-458-5512
Option 1 (for provider), then option 4, then option 3 |
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Clinical Appeals
Provider appeals for denial of medical services excluding pharmacy appeals. |
1-800-458-5512
Option 1 (for provider), then option 4, then option 3 |
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Utilization Management
Prior authorization of procedures or coordination of services such as transplant, home health, skilled nursing facilities or durable medical equipment. |
1-800-458-5512
Option 1 (for provider), then option 4, then option 2 |
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Clinic Advocacy
For high risk pregnancy, chronically or catastrophically ill members. |
888-906-0958
Fax: 952-992-3450 |
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Chiropractic Care
OptumHealthSM Care Solutions manages chiropractic care for Medica members (other than SelectCareSM and LaborCare® enrollees).
Health Services Management (HSM) manages chiropractic care for SelectCare and LaborCare enrollees. |
1-800-873-4575
651-501-9635 or 1-800-432-3640
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Claims Issues* |
Go to Claim Issues. |
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Clinical Appeals
Handles provider appeals on behalf of members for reconsideration of a non-coverage determination that requires clinical review against medical policy guidelines. |
1-800-458-5512, option 1, option 4, option 3 |
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Contracting
Handles inquiries from those interested in joining the Medica provider network, as well as contracting questions and implementation issues. |
Learn more about participating in Medica's provider network or call the Medica Provider Service Center toll free at 1-800-458-5512. |
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Credentialing & Recredentialing
Handles questions related to the credentialing and recredentialing process as well as status of applications. Providers need to be contracted with Medica (new providers should see "Contracting" above). |
Learn more about the credentialing process.
Email: credinforequest@medica.com
Voicemail: 952-992-8580
Fax: 952-992-2249 |
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Demographic Changes: Participating Practitioners/Sites
Practitioner changes: To add/remove a practitioner to/from a site, Minnesota Uniform Practitioner Change form must be submitted in writing via mail, fax or e-mail.
Clinic/site changes: Medica clinic change form must be submitted in writing via mail, fax or e-mail.
Note: In order to terminate a site, or to make changes to a federal ID, clinic name, or check name, contact your contract manager. |
Voicemail: 952-992-8580
Fax: 952-992-3897
Email: demographicchangerequests@medica.com
To learn more or make a change request, see Demographic Change Requests on medica.com. |
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Electronic Commerce
Electronic data interchange (EDI) information, products and support. Responsible for automation of provider-to-health plan transactions, including implementation and support of HIPAA-mandated transactions. |
Email: medica.electroniccommerce@medica.com
or call the Provider Service Center toll-free at
1-800-458-5512, option 1 |
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Eligibility Verification & Benefits
Verification of member numbers and eligibility.
Verification of member copayments, deductibles and basic benefits. |
1-800-458-5512, option 1, then option 1 (for the automated system) or option 2 (to speak with a representative) |
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Fraud, Waste and Abuse Training and Reporting
Confidential phone line to report suspected fraud. |
952-992-2237 or 1-866-821-1331
Learn more about Fraud, Waste and Abuse. |
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Inpatient Admission Notifications
Handles notifications for current hospital inpatient admissions related to Medica members. |
1-800-458-5512, option 1, option 4, option 1.
Fax: 952-992-3555
Email: inpatientadmission@medica.com |
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Mental Health & Substance Abuse Services
Medica Behavioral Health provides and manages mental health and substance abuse (MH/SA) services for most Medica members; handles benefits, prior authorization, claims issues, and service access questions.
SelectCare MH/SA network provides and manages services for some SelectCare enrollees. |
Central Intake: 1-800-848-8327
Fax: 1-866-863-5772
Claims: 1-866-214-6829
Fax: 1-866-863-5771
TTY/TDD: 1-800-534-7162
1-800-633-3511
Fax: 1-866-863-5770 |
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Pharmacy Questions
Rx claims processing via electronic submission and general information via telephone. Responds to drug formulary exceptions and drug prior authorization requests (accepted by fax or phone only). |
MedImpact: 1-800-788-2949
Fax: 1-858-578-9732
Medco: 1-877-842-6048
All other inquiries: 1-800-458-5512, option 1, then option 3, option 3 |
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Population Health Management and Health Coaching
Development and implementation of programs, such as health management and preventive health programs, which are designed to support the health needs of members within specific populations, including whole-patient coaching for those with multiple health conditions. |
1-866-905-7430 |
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Provider Literature Request Line
Order provider directories, provider communications, referral forms, formularies, administrative manuals, adjustment request forms, late claim appeal forms, practitioner change forms and other materials printed on paper. |
952-992-2355 or 1-800-458-5512, option 1, option 5, ext. 2-2355
Email: providercollege@medica.com |
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Provider Service Center
This call center responds to provider questions on claims issues, benefits, eligibility, provider numbers, and other topics. There is a self-help feature for automated information as well as the option to talk to a representative. Several options are also available as electronic transactions online. |
1-800-458-5512, option 1, then option 1 (for the automated system) or option 2 (to speak with a representative) |
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Quality Improvement
Handles member complaints regarding quality of care and/or service for care received, as well as required quarterly quality-of-care complaint reports from Minnesota clinics. Conducts medical record reviews and site visits for quality improvement. |
1-800-625-7824 or 952-992-3208
Fax: 952-992-3880 |
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Referrals
Handles Medica EssentialSM, Medica Elect®, Medica DUAL Solution®(MSHO) and Allina Advantage administrative referral authorizations and coordination of referral changes by member care coordinators. |
1-800-458-5512, option 1, option 4, option 1
Fax: 952-992-8090
Email: referralinquiry@medica.com |
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Social Services (coordinates community resources)
Commercial, Medicare products
State Public Programs (SPP) |
952-992-8533
952-992-3535
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