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Medica Administrative Manual Home > Billing and Reimbursement  

Billing and Reimbursement

Categorized below are various tools and forms Medica has developed to assist its provider network with understanding Medica's billing and reimbursement processes.

Claim Analysis and Recovery: Access to analysis processes and recovery tools and forms.

Claim Submission Requirements for Convenience Care Health Services: Billing code requirement for billing convenience care health services in a retail clinic setting.

Claim Submission Requirements for Facilities: How to submit claims, interpret Medica's response and request adjustments.

Claim Submission Requirements for Professional Services: How to submit claims, interpret Medica's response and request adjustments.

Coding Resources: Access to code updates, guidelines and frequently asked questions.

Commercial Fee Schedule Update Policy and Commercial Fee Schedule Release Policy: Guidelines for commercial fee schedule implementation at Medica.

Coordination of Benefits (COB): How to handle COB claims and calculations, including Medicare claims.

Electronic Transactions: Log in to view eligibility, referrals, provider number inquiry and electronic provider remittance advice (EPRA). A variety of information and tools are available for real-time transactions, such as eligibility and claim status.

Interim Rate Changes from CMS: How to notify Medica of a CMS interim rate change.

Mailing Addresses for Claims: Contact information for submitting claims to Medica.

Provider Remittance Advice: A summary of reimbursements made on submitted claims.

Reimbursement Policies: Provides payment methodology for medical and surgical services and supplies.

Date: 6/20/2019 7:28:43 AM Version: 4.0.30319.42000 Machine Name: PWIVE-CMSWEB02