Provider Contacts and Resources

Help with developing and implementing health management and preventive health programs that support the health needs of members within specific populations, including whole-patient coaching for those with multiple health conditions including high risk pregnancy, chronically or catastrophically ill members.

Phone: 1 (866) 905-7430

Specific information related to Care Management programs

See Member ID Card for Chiropractic contact information, varies by product

List of Eligible Chiropractic Codes for Commercial and IFB members that utilize the Optum Health Physical Health network

Handles provider appeals for reconsideration of a non-coverage determination that requires clinical review against medical policy guidelines.

Provider Service Center: 1 (800) 458-5512

Log into Electronic Transactions to initiate a claim appeal request online

For questions related to pending applications or existing contracts:

Email NetManQuest@medica.com
Provider Service Center: 1 (800) 458-5512

Direct Contracting with Medica

Learn about contracting with Medica

Contracting with Blue Cross Blue Shield of Arizona

AZBlue – Healthcare Professionals: Contract with BCBSAZ

Contracting with First Health

Request to join the Aetna network
Select “Medical - Request for Participation” and then select “First Health”

Contracting with Zelis Healthcare

Zelis Healthcare: 1 (888) 621-7900

Email Zelis Provider Support: providersupport.integrity@zelis.com

For questions about credentialing, recredentialing, or to confirm if your application has been received.

Learn More

Learn about Medica's credentialing process

Questions

Email MedicaDemoResolution@medica.com

Demographic changes may include:

• Adding/terminating a site to/from an existing contract
• Changing a care delivery site name or address
• Changing a directory address
• Changing federal ID
• Adding/terminating practitioners to/from sites

Log into Electronic Transactions to view or update provider demographics

Learn More

Learn about making demographic changes

Questions

Email MedicaDemoFormSubmis@medica.com

This is not available to leased network providers. If you are leased network provider who needs to update demographic information, contact your leased network directly.

Get support with our electronic data interchange (EDI) information, products and support including automation of provider-to-health plan transactions and implementation and support of HIPAA-mandated transactions. 

Provider Service Center: 1 (800) 458-5512.

Email Medica.ElectronicCommerce@medica.com

Call to verify member numbers and eligibility, copayments, deductibles and basic benefits.

Log into Electronic Transactions to perform an Eligibility Inquiry

Provider Service Center: 1 (800) 458-5512

Medica offers a confidential phone line to report suspected fraud or abuse.

Medica Integrity Line: 1 (866) 595-8495

Learn about preventing and reporting fraud, waste and abuse

To notify Medica about a current inpatient admission for one of our members.

Log into Electronic Transactions to submit an online Admission Notification

Provider Service Center: 1 (800) 458-5512

Fax: (952) 992-3555

Email: admissionsintake@medica.com

Get help with:

• Medical claims inquiries
• Medical-related dental issues
• General coding questions

Log into Electronic Transactions to Check Claim Status online

Provider Service Center: 1 (800) 458-5512

See Member ID Card for Pharmacy contact information, varies by product 

Prior authorization and services for products that utilize the ESI pharmacy network

Call to order paper copies of the following items:

• Provider directories
• Provider communications
• Referral forms
• Formularies
• Administrative manuals
• Adjustment request forms
• Late claim appeal forms
• Practitioner change forms
• Other paper materials

Provider Service Center: 1 (800) 458-5512
     Select option 1, then option 8, and then enter ext. 2-2355

We provide assistance with member complaints regarding quality of care or service. We also produce the required quarterly quality-of-care complaint reports from Minnesota clinics. Finally, we conduct medical record reviews and site visits for quality improvement.

About our Quality Improvement Program

Medica requires referrals for certain products and services. Visit the Administrative Referrals/Care Direction page for more information on plans that require referrals or prior authorization to be seen outside the network. See Referral Processes on the Claim Tools page for additional referral guidelines and request forms. 

Provider Service Center: 1 (800) 458-5512
Fax: (952) 992-8090
Email: ReferralInquiry@medica.com

For assistance with prior authorization of procedures or coordination of services such as:

• Transplant
• Home health
• Skilled nursing facilities
• Durable medical equipment (DME)

Provider Service Center: 1 (800) 458-5512

Utilization Management and Prior Authorization Guidelines