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No Surprises Act

Here are instructions and forms related to the No Surprises Act for out-of-network providers to dispute the payment rate they received from Medica (open negotiation must be exhausted prior to IDR initiation): 

These forms should be returned to Medica at:

Medica
Attn: Dispute Resolution
Mail Route CW299
PO Box 9310
Minneapolis, MN 55440-9310

E-mailbox: SurpBillDisputeRes@medica.com

Questions? Call the Medica Provider Service Center at 1 (800) 458-5512.

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Timely Filing

Date: 7/1/2022 3:52:50 PM Version: 4.0.30319.42000 Machine Name: PWIM4-CDWEB01