Providers

Request a Medical Technology Assessment

Medica makes every effort to conduct a thorough evaluation of new and emerging technologies using an evidence-based approach.

To complete this form you will need to include such information as: a well-designed and well-conducted investigation published in peer-reviewed journals, technology assessment reports, FDA and other regulatory approval status, and local physician input.

First name

Last name

Clinic or company name

Phone number

Are you a Clinical Provider or a Vendor?

Clinical Provider

Vendor

Is this regarding an existing Medica coverage policy?

Yes

Name of policy