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Medica Claim Submission and Product Guidelines

Select the appropriate Payer ID below to view Medica claim submission and product guidelines for each plan.

Address for Claims and Claim Appeals
Medica
PO Box 30990
Salt Lake City, UT 84130-0990
Attachment/Appeal Fax#

1-801-994-1076

Claim Adjustment or Appeal Request Form (DOC)

Claim Numbers

5 digit groups: Claim numbers are 10 digits (CMS-1500) and 11 digits (UB-04);

6 digit groups: Claim numbers are 12 digits

Electronic Commerce
Medica.com Provider Portal
Electronic Funds Transfer (EFT) Payments Optum Health Financial Services
1-866-842-3278, option 5

Prior Authorization Submission

Prior Authorization submitted via email and/or fax number provided on the corresponding form

Inpatient Notification Submission Medica.com Provider Portal/Admission Notification
Inpatient Admission – Notification Guidelines
Referral Submission Medica.com Provider Portal/Administrative Referral Entry for referral based products
Clinical Guidelines
Policies and Guidelines on Medica.com
Provider Service Center

1-800-458-5512 

Pharmacy
BIN/PCN/Group # vary by product – see member's ID card
Chiropractic Care

Benefits/Claims: Medica – 1-800-458-5512
Authorizations: Optum – 1-800-873-4575

Behavioral Health
Medica Behavioral Health (MBH): 1-800-848-8327

Product Fact Sheets

Altru & You With Medica
Clear Value With Medica
Essentia Choice Care with Medica
Medica Choice Passport
Medica CompleteHealth
Medica Elect and Medica Essential
Medica Focus
Park Nicollet First with Medica
Ridgeview Community Network powered by Medica
VantagePlus with Medica
Medica AccessAbility Solution / Special Needs Basic Care (SNBC)
Medica AccessAbility Solution Enhanced / Special Needs Basic Care (SNBC SNP)
Medica Dual Solution/Minnesota Senior Health Options (MSHO)
Medica Choice Care MSC+/Minnesota Senior Care Plus (MSC+)
Medica Prime Solution
Medica Select Solution
Medica Signature Solution
University of Minnesota

Address for Claims and Claim Appeals

Medica Individual & Family Business
PO Box 21051
Eagan, MN 55121-0051

 

Attachment/Appeal Fax#

1-952-992-1427

Claim Adjustment or Appeal Request Form (DOC)

Claim Numbers

11 digits

Electronic Commerce

Medica.com Provider Portal

Availity EDI Portal

Electronic Funds Transfer (EFT) Payments

InstaMed: 1-866-945-7990
Email: connect@instamed.com

Website:
Register
Login

Prior Authorization Submission

Prior Authorization submitted via email and/or fax number provided on the corresponding form

Inpatient Notification Submission Fill out the Inpatient Notification Form on Medica.com
Inpatient Admission – Notification Guidelines

Clinical Guidelines

Policies and Guidelines on Medica.com

Provider Service Center

1-800-458-5512 

Pharmacy

ExpressScripts (ESI). BIN/PCN/Group # vary by product — see member's ID card

Chiropractic Care

Benefits/Claims – Medica: 1-800-458-5512

Authorizations/treatment plans are not required

Eligible Chiropractic Codes for Commercial and Individual Plans Only

Behavioral Health

2020 – Medica Provider Service Center: 1-800-458-5512

2021 – Medica Behavioral Health (MBH): 1-800-848-8327

Medica Behavioral Health
PO Box 30757
Salt Lake City, UT 84130

Payer ID: 87726

Product Fact Sheets

Altru Prime by Medica
Balance by Medica
Bold by M Health Fairview
Elevate by Medica
Empower by Medica
Engage by Medica
Harmony by Medica
Inspire by Medica
Medica Applause
Medica Connect
Medica Direct HSA
Medica Direct Value
Medica Encore
Medica Individual Choice
Medica Insure
Medica Quest
Medica Solo
Medica Symphony HSA
Medica with CHI Health
Medica with Healthier You
Medica with MU HealthCare
North Memorial Acclaim by Medica
Ridgeview Distinct by Medica
Select by Medica

Address for Claims and Claim Appeals (paper submission and correspondence)

Medica
PO Box 211435
Eagan, MN 55121

Attachment/Appeal Fax#

952-992-3024

Claim Adjustment or Appeal Request Form (DOC)

Claim Numbers

13 digits

Electronic Commerce

Medica.com Provider Portal

Availity EDI Portal

Electronic Funds Transfer (EFT) Payments

InstaMed: 1-866-945-7990
Email: connect@instamed.com

Website:
Register
Login

Prior Authorization Submission

Prior authorization submitted via email and/or fax number provided on the corresponding form

Inpatient Notification Submission Fill out the Inpatient Notification Form on Medica.com
Inpatient Admission – Notification Guidelines

Clinical Guidelines

Policies and Guidelines on Medica.com

Provider Service Center

1-800-458-5512 

Pharmacy

Varies by product – see member's ID card

Chiropractic Care

Varies by product – see member's ID card

Behavioral Health

Any provider within the available networks (see applicable provider fact sheet below for directory). 

Product Fact Sheets

Mayo Medical Plan
Medica Choice National
Medica with CHI Health Direct Primary Care (DPC)
Medica with CHI Health Fact Sheet (Accountable Care System Product)
Medica Health Plan Solutions

Address for Claims and Claim Appeals (paper submission and correspondence)

Medica
PO Box 211435
Eagan, MN 55121

BCBS AZ providers submit to payer ID 53589

Attachment/Appeal Fax#

952-992-3024

Claim Adjustment or Appeal Request Form (DOC)

Claim Numbers

13 digits

Electronic Commerce

Medica.com Provider Portal

Availity EDI Portal

Electronic Funds Transfer (EFT) Payments

InstaMed: 1-866-945-7990
Email: connect@instamed.com

Website:
Register
Login

Prior Authorization Submission

Prior Authorization submitted via email and/or fax number provided on the corresponding form

Inpatient Notification Submission Fill out the Inpatient Notification Form on Medica.com
Inpatient Admission – Notification Guidelines

Clinical Guidelines

Policies and Guidelines on Medica.com

Provider Service Center

1-800-458-5512

Pharmacy

Alluma

1-833-789-5310
Bin: 005377
Rx PCN:10000019
RxGroup: MAYORX

Chiropractic Care

BCBS AZ provider network

Payer ID: 53589

Behavioral Health

BCBS AZ provider network

Payer ID: 53589

Product Fact Sheet

Mayo Medical Plan AZ

Claim Address (paper submission and correspondence)

2020 Claims:
Zelis/Medica PMB 404
15560 N. Frank Lloyd Wright Blvd.
Scottsdale, AZ 85260

2021 Claims:
Zelis/Medica
PO Box 2839
Farmington HIlls, MI 48333

Address for Claim Appeals

Medica
PO Box 211435
Eagan, MN 55121

Attachment/Appeal Fax#

952-992-3024

Claim Adjustment or Appeal Request Form (DOC)

Claim Numbers

13 digits

Electronic Commerce

Medica.com Provider Portal

Availity EDI Portal

Electronic Funds Transfer (EFT) Payments

InstaMed: 1-866-945-7990
Email: connect@instamed.com

Website:
Register
Login

Prior Authorization Submission

Prior Authorization submitted via email and/or fax number provided on the corresponding form

Inpatient Notification Submission Fill out the Inpatient Notification Form on Medica.com
Inpatient Admission – Notification Guidelines

Clinical Guidelines

Policies and Guidelines on Medica.com

Provider Service Center

1-800-458-5512

Pharmacy

Alluma

1-833-789-5310
Bin: 005377
Rx PCN: 10000019
RxGroup: MAYORX

Chiropractic Care

Zelis provider network

Zelis/Medica PMB 404
15560 N. Frank Lloyd Wright Blvd.
Scottsdale, AZ 85260

Payer ID: 88090

Behavioral Health

Any available provider within the Zelis network

Zelis/Medica PMB 404
15560 N Frank Lloyd Wright Blvd
Scottsdale, AZ 85260

Payer ID: 88090

Product Fact Sheet

Mayo Medical Plan FL

Address for Claims and Claim Appeals

Medica Government Programs
PO Box 21342
Eagan, MN 55121-0342

Attachment/Appeal Fax#

952-992-3899

Claim Adjustment or Appeal Request Form (DOC)

Claim Numbers

13 digits

Electronic Commerce

Medica.com Provider Portal

Electronic Funds Transfer (EFT) Payments

InstaMed: 1-866-945-7990
Email: connect@instamed.com

Website:
Register
Login

Prior Authorization Submission

Prior Authorization submitted via email and/or fax number provided on the corresponding form

Inpatient Notification Submission Fill out the Inpatient Notification Form on Medica.com
Inpatient Admission – Notification Guidelines

Clinical Guidelines

Policies and Guidelines on Medica.com

Provider Service Center

1-800-458-5512

Pharmacy

Rx Bin: 003858
Rx PCN: MD
Rx Group: 2Medica

Chiropractic Care

Benefits/Claims – Medica: 1-800-458-5512

Authorizations – Optum: 1-800-873-4575

Optum Chiropractic for Medicare Advantage
PO Box 212
Minneapolis, MN 55440-0212

Payer ID: 41161

Behavioral Health

Medica Behavioral Health (MBH): 1-800-848-8327

PO Box 30757
Salt Lake City, UT 84130

Payer ID: 87726

Product Fact Sheets

Medica Advantage Solution HMO Fact Sheet
Medica Advantage Solution HMO-POS Fact Sheet
Medica Advantage Solution PartnerCare HMO I-SNP
Medica Advantage Solution PPO Fact Sheet

Date: 9/16/2021 4:24:43 PM Version: 4.0.30319.42000 Machine Name: PWIVE-CDWEB02