• The original member ID submitted on claim will report in Patient Name (NM1 with QC Qualifier) and Insured Name (NM1 with IL Qualifier) segments, if applicable.
• If submitted member ID is different than adjudicated member ID, the 9-digit corrected member identification number will be returned in Corrected Patient/Insured Name (NM1 with 74 Qualifier) segment.
• The group number will report in Other Claim Related Identification (REF with 1L Qualifier) segment.
• If a proprietary patient relationship code is submitted on claim as part of member ID, it will be reported in NM1 QC/IL; otherwise, the proprietary patient relationship code will no longer be reported.

• Gardasil® is covered for the FDA-approved indications for female and male patients 9-26 years of age;
• Cervarix® is covered for the FDA-approved indications for female patients 9-26 years of age.

• see pending, paid, payable and denied status of claims
• see when claims were paid or denied
• search claims by patient name or by patient ID number

Each time Medica adds a new electronic function online, users need to have their account updated by their Primary Administrator to obtain access to the new function. For more details on the new claims status functionality, providers can:

• Refer to a User Guide for Medica Electronic Transactions.
• Call the Medica Provider Service Center at 1 (800) 458-5512.

• "Urethral Bulking Agents for Urinary Incontinence"
• "Sacral Nerve Stimulation"
• "Extracorporeal Magnetic Stimulation (EMS) for the Treatment of Urinary Incontinence"
• "Radiofrequency Bladder Neck Suspension for Treatment of Stress Incontinence in Women (SURx^®)"

• Treatment of breast cancer after HER2 overexpression is confirmed using FDA-approved assays in accordance with current guidelines from the American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP).
• Treatment of advanced gastric cancer after HER2 overexpression is confirmed using FDA-approved assays.

Herceptin continues to be considered investigative and therefore remains not covered for all other indications including, but not limited to, treatment of breast cancer or gastric cancer that does not overexpress HER2, as well as treatment of all other cancers.

• Product Grid – Chiropractic – Government, Minnesota
  • Overview of group numbers, provider network, clinical submission requirements and general services covered for Medica government products.
• Product Grid – Medicare, Minnesota
  • Summary of group numbers, provider network, primary payer (Medica vs. Medicare) and admission requirements for Medica Medicare products.
• MHCP Overview of Benefits SPP Copay Grid
  • Overview of group numbers and copayment information on selected services.
• SNP and MSC+ Group Numbers
  • Details on group numbers, care systems and product types for Medica Special Needs Plans (SNPs) and Minnesota Senior Care Plus (MSC+).
• Vision Care at a Glance
  • Overview of product types and general coverage information for refractive exams and eyewear coverage.

• "Quick Facts for Clinicians on Antiviral Treatments for 2009 H1N1"
• CDC Health Alert: "Key Issues for Clinicians Concerning Antiviral Treatments for 2009 H1N1"

• The MDH blood lead guideline.
• The C&TC Provider Guide (starting on p. 144).
• "Lead Poisoning Prevention" from MDH.

• Claim Adjustment Request Form—(for non-Minnesota network providers) To be used when a non-Minnesota network provider has additional data that should have been submitted on the original claim or has a need to correct data that was sent incorrectly on the original claim. (Minnesota providers must follow the AUC guide for electronic submission of voided or replacement claims)
• Claim Appeal Request Form—(for all network providers) To be used when a network provider is requesting reconsideration of a previously adjudicated claim but there is no additional or corrected data to be submitted. Claim appeals need to be submitted within 180 days of the original claim's disallow date.