• Calling 1-800-458-5512 (option 1, option 4). 
• Faxing 952-992-3556 or 952-992-3554.
• Sending an electronic Prior Authorization Form.
• Mailing it to:

Medica Care Management
Route CP440
PO Box 9310
Minneapolis, MN 55440-9310

Prior authorization does not guarantee coverage. Medica will review the prior authorization request and respond to the provider (by phone call) within two business days after the date that the request was received, as long as all reasonably necessary information is provided to Medica. In order to better serve Medica’s members, providers are encouraged to submit their request at least 10 days prior to the service being provided.


Prior Authorization Requirements

Prior authorization is required for selected non-radiology services. For providers to obtain prior authorization, Medica requires that the following information be provided:

1. Name and phone number of the provider who is making the request. 
2. Name, phone number, address and type of specialty of the provider to whom the patient is being referred, if applicable. 
3. Services being requested and the date those services are to be rendered (if scheduled). 
4. Specific information related to the patient’s condition (clinical rationale for service being requested.)

For more information on which services require participating providers to obtain prior authorization from Medica, please review the current Prior Authorization List of medical services. You may also order a printed copy of the prior authorization list by calling Medica’s Provider Literature Request Line at 1-800-458-5512 (option 1, option 5, ext. 2-2355). 

Download Prior Authorization List.

To find out if a member is eligible for a service, providers may call Medica’s Provider Service Center at 1-800-458-5512 (option 2).


Utilization Management

If the provider would like to discuss any utilization management (UM) decisions with Medica’ s Medical Director and/or Care Management staff, contact Care Management at the numbers listed in this section. For general UM inquiries, the provider may also contact Provider Services at 1-800-458-5512 (option 2) or reference Medica's current Utilization Management Policies.

While it is expected that prior authorization be obtained before services are rendered, Medica reserves the right to conduct a medical necessity review at the time the claim is received, if authorization was not previously requested.

Please note: Medica retains the option to require prior authorization in situations of proven high utilization.


Surgery for Weight Loss

Providers are required to obtain prior authorization for weight loss surgery. Certain members need to receive services from approved providers in Medica’s Centers of Excellence for Bariatric Care program to receive their highest benefit level.

Depending on the member’s current coverage, claims may be denied if the member sees a non-Centers of Excellence provider. Denial of coverage will depend on the member’s coverage document on or after July 1, 2006.

For commercial members:

• Benefits will vary by employer group and will be denied as member liability, where applicable.

For Medica’s Minnesota Health Care Programs (MHCP) enrollees:

• Surgery will be denied as provider liability, where applicable. 
• Members will have no out-of-network benefit for non-Centers of Excellence providers.

To find an approved hospital and surgeon, review Medica's Center of Excellence for Bariatric Care Approved Provider List. Due to the ongoing approval process for the program, this list is subject to change. 

Download Approved Provider List.

Please note: Bariatric surgery will continue to require prior authorization.


Return to Administrative Policies and Procedures.