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Provider Contacts and Resources

The secure self-service Provider Portal contains a lot of useful information including:

• Administrative Referral Entry
• Admission Notification
• Check Claim Status
• Electronic Payments and Statements
• Eligibility Inquiry
• Referral Status Inquiry and Modification
• Request a Claim Adjustment or Appeal
• Clinic Demographics
• Fee Schedule Download/Lookup
• Provider Search

Provider Service Center:

Questions about how to utilize self-service options on the website or other inquiries can be directed to our highly-trained representatives in the Provider Service Center at:

1-800-458-5512

Monday – Friday, 7 a.m. to 5 p.m., Central
Closed Monday 8 to 9 a.m. for training

 

Contacts by Category

Select the appropriate option under each category to find direct contact information.

 

Care Management and Health Improvement Programs

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


Chiropractic

Clinical Appeals

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

Contracting

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

Credentialing and Recredentialing

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

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

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.

Electronic Data Interchange (EDI)

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

Eligibility Verification and Benefits

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

Provider Service Center: 1-800-458-5512

Fraud, Waste, and Abuse

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

Inpatient Admission Notifications

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

Provider Service Center: 1-800-458-5512

Fax: 952-992-3555

Email: admissionsintake@medica.com

Medica Claims

Get help with:

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

Provider Service Center: 1-800-458-5512

Mental Health and Substance Use Disorder Services

For help with benefits, prior authorization, claims issues and service access questions, please contact Medica Behavioral Health:
 
Intake/Benefits: 1-800-848-8327; Rightfax: 1-855-454-8155
Claims: 1-866-214-6829; Rightfax: 1-866-675-5955; TTY: 771 

Pharmacy

Provider Literature Request Line

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

Quality Improvement

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

Referrals

We coordinate referrals for our Medica Essential and Medica Elect members. We also perform ACO administrative referral authorizations and coordination of referral changes by member care coordinators.

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

Utilization Management

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

Medica Prior Authorization and Notification Requirements (PDF)



REV 10/2022


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