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Medica Administrative Manual Home > Medica Points of Contact > Contact Medica

Contact Medica

Provider Service Center 1-800-458-5512

Hours of Service
Monday - Thursday from 8:30 a.m. - 5 p.m.
Friday from 9 a.m. - 5 p.m.

Other Points of Contact

Department and Responsibility Contact Information

Benefit Appeals
Provider appeals on behalf of members for claims issues when denied as member liability.

1-800-458-5512

Chiropractic Care
Medica handles chiropractic care for members with group/policy number "IFB".

OptumHealthSM Care Solutions manages chiropractic care for Medica members (other than SelectCareSM and LaborCare® enrollees).

Health Services Management (HSM) manages chiropractic care for SelectCare and LaborCare enrollees.

1-800-458-5512


1-800-873-4575


651-501-9635 or 1-800-432-3640

Clinic Advocacy
For high risk pregnancy, chronically or catastrophically ill members.

888-906-0958
Fax: 952-992-3450

Clinical Appeals
Handles provider appeals on behalf of members and providers for reconsideration of a non-coverage determination that requires clinical review against medical policy guidelines.

1-800-458-5512

Contracting
Handles inquiries from those interested in joining the Medica provider network, as well as contracting questions and implementation issues.

Learn more about participating in Medica's provider network or call the Medica Provider Service Center toll free at 1-800-458-5512.

Credentialing & Recredentialing
Handles questions related to the credentialing and re-credentialing process as well as status of applications.

Providers need to be contracted with Medica (new providers should see "Contracting" above).

Email: MedicaDemoResolution@medica.com

Learn more about the credentialing process »

Demographic Changes: Participating Practitioners/Sites

Use the secure provider demographic-update online tool (PDOT) to make site-level and individual practitioner adds, terms or changes for Medica and Patient Choice products. Make demographic changes such as:

  • 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

Additional practitioner change options are available by submitting the Minnesota Uniform Practitioner Change form. For additional contract-related requests, contact your contract manager.

Email: MedicaDemoFormSubmis@medica.com

To learn more or make a change request, see Demographic Change Requests.

Dental Claims
Delta Dental of Minnesota answers dental claims questions.

Commercial:
651-406-5914 or 1-800-981-8125

Medicaid:
651-406-5919 or 1-800-459-8574

Electronic Commerce
Electronic data interchange (EDI) information, products and support.

Responsible for automation of provider-to-health plan transactions, including implementation and support of HIPAA-mandated transactions.

Email: medica.electroniccommerce@medica.com
or call the Provider Service Center toll-free at 1-800-458-5512

Eligibility Verification & Benefits
Verification of member numbers and eligibility.

Verification of member copayments, deductibles and basic benefits.

1-800-458-5512

Fraud, Waste and Abuse Training and Reporting
Confidential phone line to report suspected fraud.

952-992-2237 or 1-866-821-1331

Learn more about Fraud, Waste and Abuse »

Inpatient Admission Notifications
Handles notifications for current hospital inpatient admissions related to Medica members.

1-800-458-5512
Fax: 952-992-3555
Email: inpatientadmission@medica.com

Medica Claims
Medical claims inquiries, medical-related dental issues and general coding questions..

1-800-458-5512, option 1, then option 1 for the automated system, or option 2 to speak with a representative.

Mental Health & Substance Abuse Services
For group/policy number "IFB", Medica handles benefits, claim issues and service access questions using the Optum SelectCare network. Optum SelectCare handles authorizations for most inpatient services.

Medica Behavioral Health provides and manages mental health and substance abuse (MH/SA) services for most Medica members; handles benefits, prior authorization, claims issues, and service access questions.

SelectCare MH/SA network provides and manages services for some SelectCare enrollees.

 

Benefits, Claims, Service Access:
1-800-458-5512

Intake: 1-800-848-8327
Fax: 1-866-863-5772
Claims: 1-866-214-6829
Fax: 1-866-863-5771
TTY/TDD: 1-800-534-7162

1-800-633-3511
Fax: 1-866-863-5770

Pharmacy Questions

Rx claims processing via electronic submission and general information via telephone.

Responds to drug formulary exceptions and drug prior authorization requests (accepted by fax or phone only).

CVS Caremark inquiries »

MedImpact inquiries »

Population Health Management and Health Coaching
Development and implementation of programs, such as health management and preventive health programs, which are designed to support the health needs of members within specific populations, including whole-patient coaching for those with multiple health conditions.

 1-866-905-7430

Provider Literature Request Line
Order provider directories, provider communications, referral forms, formularies, administrative manuals, adjustment request forms, late claim appeal forms, practitioner change forms and other materials printed on paper.

1-800-458-5512, option 1, option 5,
ext. 2-2355
Email: providercollege@medica.com

Provider Service Center
This call center responds to provider questions on claims issues, benefits, eligibility, provider numbers, and other topics.

There is a self-help feature for automated information as well as the option to talk to a representative. Several options are also available as electronic transactions online.

1-800-458-5512

Quality Improvement
Handles member complaints regarding quality of care and/or service for care received, as well as required quarterly quality-of-care complaint reports from Minnesota clinics. Also conducts medical record reviews and site visits for quality improvement.

1-800-625-7824 or 952-992-3208
Fax: 952-992-3880

Referrals
Handles Medica EssentialSM, Medica Elect®, and ACO administrative referral authorizations and coordination of referral changes by member care coordinators.

1-800-458-5512
Fax: 952-992-8090
Email: referralinquiry@medica.com

SelectCare Claims
Responds to questions about the re-pricing of SelectCare claims. 

SelectCare cannot verify eligibility or benefits. These questions should be directed to payer listed on enrollee’s ID card. 

SelectCare cannot mail out Provider Directories.

952-992-2500 or 1-800-858-9060

Social Services (coordinates community resources)
Commercial, Medicare products
State Public Programs (SPP)

952-992-8533
952-992-3535

Utilization Management
Prior authorization of procedures or coordination of services such as transplant, home health, skilled nursing facilities or durable medical equipment.

1-800-458-5512

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