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• 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
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.
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
For questions related to pending applications or existing contracts:
Email NetManQuest@medica.com Provider Service Center: 1-800-458-5512
Learn about contracting with Medica
AZBlue – Healthcare Professionals: Contract with BCBSAZ
Request to join the Aetna network Select “Medical - Request for Participation” and then select “First Health”
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 about Medica's credentialing process
Email MedicaDemoResolution@medica.com
Demographic changes may include:
Learn about making demographic changes
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.
Medica offers a confidential phone line to report suspected fraud.
Medica Fraud Hotline: 1-866-821-1331
Learn about preventing and reporting fraud, waste and abuse
To notify Medica about a current inpatient admission for one of our members.
Fax: 952-992-3555
Email: admissionsintake@medica.com
Get help with:
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 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
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
For assistance with prior authorization of procedures or coordination of services such as:
Utilization Management and Prior Authorization Guidelines
Medica Prior Authorization and Notification Requirements (PDF)
REV 11/2021