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Medica Provider Administrative Manual

To Participating Providers
Cover Page
Table of Contents
Chapter 1: How to Use This Manual
Chapter 2: Medica Products
    Provider Requirements for Medicare, Medicaid and State Government Program Products
Chapter 3: Provider Services
Chapter 4: Member Assistance Services
Chapter 5: Care Management
Chapter 6: Medical-related Dental Services
Chapter 7: Mental Health/Substance Abuse Services
Chapter 8: Pharmacy Services
Chapter 9: Credentialing
Chapter 10: Administrative Referrals
Chapter 11: Claim Submission - Professional Services
Chapter 12: Claim Submission - Facilities
    New Policy: Adverse Health Events Policy
Chapter 13: Clinical Review
Chapter 14: Quality Guidelines and Improvement
Chapter 15: Provider Agreement
Chapter 16: Well Child Checkups (Child & Teen Checkups)
Chapter 17: Regulatory/Reporting Information
     HIPAA Business Associate Requirements for Providers
Chapter 18: Medica Prime Solution Regulations
Chapter 19: Board and Committees
Chapter 20: Fraud and Abuse
Chapter 21: Provider Electronic Transaction
Appendix 1: Glossary of Terms
InvestigativeInquiryForm
General Inquiry Instructions