Upon request, Medica will prepare a demographic data validation report in an electronic spreadsheet based on a provider's tax ID number and then send it to the provider.
Providers can then verify the information contained in the validation report to ensure that Medica has accurate and current demographic data.
Clinics or sites that are interested in participating in this project are invited to contact our Provider Operations team at MedicaDemoResolution@medica.com. Providers should include contact name, phone number, clinic name and tax ID.
Provider Directories
It is important that patients and members have access to accurate, up-to-date information when seeking care in their provider network. Providers need to regularly update their demographic data based on the Centers for Medicare and Medicaid Services (CMS ) rules.
To ensure that members have the best experience possible when looking for care, health plans need providers’ help to ensure provider details and clinic locations are up-to-date. Providers should update their practitioner and site-level information regularly or as soon as they know of a change to that data. Information in Medica’s provider directories can be reviewed and edited through the secure Provider Demographic-Update Online Tool (PDOT) or the Add/Term/Change (ATC) Form (DOC).
One key element for accuracy in provider directories is for providers to indicate exactly where their practitioners see patients. Site-specific practitioner information needs to be accurate so when members call a site and ask for a doctor, they don’t find out the doctor doesn’t provide services there.