| Department and Responsibility |
Contact Information |
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 5. |
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 5. |
|
Care 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 3 |
|
Case Management Services
For high risk pregnancy, chronically or catastrophically ill members. |
1-800-458-5512
Option 1 (for provider), then option 4, then option 4
Fax: 952-992-3554 |
|
Chiropractic Care
American Chiropractic Networks (ACN)/ChiroCare handles Medica fully insured and self-insured other than SelectCareSM and Minnesota Senior Health Options (MSHO) program 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
|
| Claims Issues* |
Go to Claim Issues. |
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 5 or 952-992-1644 |
Contracting
Handles contracting questions and implementation issues.
|
Call your contact (e.g., contract manager) or to have your call directed, call Medica toll-free at 1-800-458-5512, option 1, then option 5, ext. 2-3461 |
|
Credentialing & Recredentialing
Handles questions related to the credentialing/recredentialing process and status of applications. |
Voicemail: 952-992-8580
Fax: 952-992-2249
E-mail: credinforequest@medica.com |
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, change a federal ID or clinic name, or check a name, contact your contract manager. |
Voicemail: 952-992-8580
Fax: 952-992-3897
E-mail: demographicchangerequests@medica.com |
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.
|
E-mail: medica.electroniccommerce@medica.com
or call the Provider Service Center toll-free at
1-800-458-5512, option 1 |
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) |
Fraud Hotline
Confidential phone line to report suspected fraud.
|
952-992-2237 or 1-866-821-1331 |
Inpatient Admission Notifications
Handles notifications for current hospital inpatient admissions related to Medica members.
|
1-800-458-5512, option 1, option 4, option 2.
Fax: 952-992-3555
E-mail: inpatientadmission@medica.com |
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 |
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 |
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.
|
952-992-8460 |
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
E-mail: providercollege@medica.com |
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)
|
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 |
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
E-mail: referralinquiry@medica.com |
Social Services (coordinates community
resources)
Commercial, Medicare products.
State Public Programs (SPP).
|
952-992-8533
952-992-3535 |
|
|
Behavioral Health
Medica Behavioral Health provides and manages mental health and substance abuse (MH/SA) services for most Medica members; handles prior authorization and service access questions.
|
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 |
|
Chiropractic Care
ACN Group, Inc. manages chiropractic care for Medica members other than SelectCare and LaborCare enrollees.
Health Services Management (HSM) manages chiropractic care for SelectCare and LaborCare enrollees. |
1-800-458-5512
651-501-9635 or 1-800-432-3640
|
Dental
Delta Dental of Minnesota answers dental claims questions.
|
Commercial: 651-406-5914 or 1-800-981-8125
Medicaid: 651-406-5919 or 1-800-459-8574 |
Medica
Medical claims inquiries, medical-related dental issues and general coding questions.
|
1-800-458-5512, option 1, then option 1 for the automated system, or option 2 to speak with a representative. |
SelectCare
Responds to questions about the re-pricing of SelectCare claims. SelectCare cannot verify eligibility or benefits. These questions should be directed to payer listed on enrollee’s ID card. SelectCare cannot mail out Provider Directories.
|
952-992-2500 or 1-800-858-9060, option 1 |