Adjustment Guidelines: Adjustments, refunds and adjustment time frames.
Administrative Referrals: Definitions, guidelines, request process and requirements.
Board and Committees: Membership of Medica’s Boards of Directors, and membership and function of Board committees.
High-Tech Imaging Program: Detailed consultation request process, claims information and resources.
Medical-related Dental Services: Explanation of prior authorization requirements, covered services and exclusions.
Medical Record Requests: Explanation of requirements when Medica requests medical records from a provider.
Notification Requirements:
Requirements and exclusions for inpatient services.
Personal Care Assistance (PCA): Administrative and billing requirements for agencies that provide PCA services.
Prior Authorization: Request process, requirements and utilization management, including weight loss surgery.
Special Transportation Driver and Vehicle Services:
Definitions and vehicle, personnel and certification requirementsTimely Filing: Submissions, resubmissions, adjustments, exceptions and late claim appeals.
Well Child Check-ups (Child & Teen Check-ups): Exams, evaluation, screenings and immunizations for Medica Choice Care (Medical Assistance and General Assistance Medical Care) and Medica MinnesotaCare members from birth to age 21.
Return to Provider Administrative Manual.