Skip to Main Content

Contacts for Providers

Provider Service Center

1-800-458-5512

Monday – Thursday, 8:30 a.m. – 5 p.m., Central
Friday, 9 a.m. – 5 p.m., Central

Our highly-trained representatives in the Provider Service Center can assist with the following inquiries and more:

  • Member eligibility
  • Member benefit product information
  • Claim information and procedures
  • Verify provider in-network status
  • Electronic claim entry rejections
  • Coordination of benefits
  • Referrals/authorizations
  • Copayments, coinsurance and deductibles
  • High-level inquiries regarding electronic submission of claims
  • Provider demographic updates and changes
  • Medica.com questions
  • Appeals questions

 

Contacts by Category

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

Search tip: Use "Ctrl+F" to enter a search term and jump directly to a category.

Chiropractic

Group Members Other than SelectCare and LaborCare

OptumHealth Care Solutions: 1-800-873-4575

SelectCare and LaborCare Members

Health Services Management: 1-800-432-3640

Benefits and Claim Status

Provider Service Center: 1-800-458-5512

Network or Repricing Issues

Minnesota, Wisconsin and All Other States Not Listed Below

Magellan: 1-800-432-3640. option 3

Arizona

Blue Cross/Blue Shield of Arizona: 1-800-232-2345, ext. 4885

Florida

Zelis Heathcare: 1-888-621-7900

Clinic Advocacy

For high risk pregnancy, chronically or catastrophically ill members.

1-888-906-0958
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.

Provider Service Center: 1-800-458-5512

Contracting

Learn about joining the Medica provider network, or look in to a contracting question or implementation issue.

Direct Contracting with Medica

Provider Service Center: 1-800-458-5512

Learn about contracting with Medica

Contracting with Blue Cross Blue Shield of Arizona

Blue Cross Blue Shield of Arizona: 1-800-232-2345, ext. 4885

Contracting with FirstHealth

FirstHealth:1-800-226-5116

Zelis Healthcare

Zelis Healthcare: 1-888-621-7900

Credentialing and Recredentialing

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

Questions

Email MedicaDemoResolution@medica.com

Learn More

Learn about Medica's credentialing process

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 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 Commerce

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 Training and Reporting

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

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: InpatientAdmission@medica.com

Medica Claims

Get help with:

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

Provider Service Center: 1-800-458-5512
     Select Option 1, then choose option 1 for the automated system or option 2 to speak with a representative.

Mental Health and Substance Abuse Services

Get help with benefits, prior authorization, claims issues and service access questions.

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

SelectCare

SelectCare Mental Health and Substance Abuse network provides and manages services for some SelectCare enrollees.

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

Get help with benefits, prior authorization, claims issues and service access questions. Medica uses the Optum SelectCare network for these members.

Provider Service Center: 1-800-458-5512

Get help with benefits, prior authorization, claims issues and service access questions.

Benefits and Claims Status

Provider Service Center: 1-800-458-5512

Network and Repricing Issues

The Mental Health and Substance Abuse network varies depending on on which provider network the member has access to.

Minnesota, Wisconsin and All Other States Not Listed Below

Provider Service Center: 1-800-458-5512

Arizona

Blue Cross/Blue Shield of Arizona: 1-800-232-2345, ext. 4885

Florida

Zelis Heathcare: 1-888-621-7900

Pharmacy

Our pharmacy claims are processed via electronic submission. We can answer general information or pharmacy questions by phone. Phone numbers are specific to the member's identification number and the code of the pharmaceutical service and can be found at the link below. Prior authorizations and appeals are handled by our pharmacy benefit manager, CVS Caremark.

Prior authorization and services

Our pharmacy claims are processed via electronic submission. We can answer general information or pharmacy questions by phone. Phone numbers are specific to the member's identification number and the code of the pharmaceutical service and can be found at the link below. Prior authorizations and appeals are handled by our pharmacy benefit manager, CVS Caremark.

Prior authorization and services

Our pharmacy claims are processed via electronic submission. We can answer general information or pharmacy questions by phone. Drug formulary exceptions and prior authorization requests are handled by Optum RX.

Optum RX: 1-844-284-0148

OptumRx health care professionals portal

Populations Health Management and Health Coaching

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.

Phone: 1-866-905-7430

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

SelectCare Claims

We respond to questions about the re-pricing of SelectCare claims.

We cannot verify eligibility or benefits. These questions should be directed to payer listed on enrollee’s ID card. We also cannot mail out provider directories.

Phone:1-800-858-9060

Social Services

We coordinate community resources for our Commercial, Medicare, and State Public Program members.

Phone: 952-992-3535

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

Medica Prior Authorization and Notification Requirements (PDF)

Date: 5/23/2019 8:13:28 PM Version: 4.0.30319.42000 Machine Name: PWIVE-CMSWEB02