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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): 

For claim payment dates prior to September 28, 2023, these forms should be returned to Medica at:

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

E-mailbox: [email protected]

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

For claim payment dates starting on September 28, 2023, the above forms should be sent to:

Medica QPA Dispute Resolution
c/o HRGi
9711 Washingtonian Blvd., Suite 300
Gaithersburg, MD 20878

E-mailbox: [email protected]

Questions? Call HRGi toll-free at 1 (800) 234-1924.


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Timely Filing

Date: 9/29/2023 1:04:43 PM Version: 4.0.30319.42000 Machine Name: PWIVE-CDWEB01