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Provider Resources

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Introducing the Medica Premium Designation Program
The Medica Premium Designation Program is a new transparency initiative that will indicate quality and cost-efficiency results for individual practitioners. This program is expected to be available by January 1, 2011.

Learn more about the Premium program.

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Welcome to Provider Resources, an information source for Medica providers including physicians and clinic and facility staffs. Here you'll find information regarding Medica's policies and programs; access administrative manuals, clinical guidelines, utilization management policies, and medical technology policies; learn about classes offered by our Provider College; log in to administer electronic transactions; and much more.

  • Electronic Transactions: Log in to electronically administer patient and claims information. Available transactions include Eligibility Inquiry, Administrative Referral Entry, Claim Adjustment Request, Admission Notification, Prior Authorization, Referral Status, and others.

  • Reference Tools and Forms: Access the administrative tools and forms, manuals, credentialing and demographic information, as well as information regarding Medica-specific product information.

  • News You Can Use: Find Provider Alerts to get important and proactive notices on Medica-related issues, policies and programs, and view Medica Connections newsletters by date. Sign up to receive updates via e-mail.

  • Medical Policies: Find current versions of Medica utilization management (UM) policies, coverage policies, Institute for Clinical Systems Improvement (ICSI) guidelines, and Medica clinical guidelines.

  • Clinical and Quality Programs: Learn about Medica's clinical programs that support both the member and provider communities in receiving and delivering high-quality, accessible health care.

  • Pharmacy: Review Medica pharmacy policies and procedures, see pharmacy-related updates, print medication request forms, and refer to the Medica Drug Formulary.

  • Events and Training: Learn more about the Medica Provider College and training sessions that are offered. The Provider College offers training to provider staffs throughout the Medica service area.

  • Contact Medica: Get general contact information for Medica and Medica Customer Service. You can contact Medica Provider Service directly at 1-800-458-5512, Monday - Thursday from
    8:30 a.m. – 5 p.m., and Friday 9 a.m. – 5 p.m.