Medica updates its Utilization Management (UM) policies regularly and reserves the right to amend these policies without notice to Medica members. Medica also reserves the right to amend these policies without notice to contracted health care providers unless the amendment materially alters the policy. If the amendment materially alters the policy, Medica will disclose the change to contracted health care providers not less than 60 days prior to implementation of the policy.
Product Application: These policies provide general information concerning our administrative processes. The service may or may not be covered by all Medica plans. Please refer to the member's plan document for specific coverage information. If there is a difference between this general information and the member's plan document, the member’s plan document will be used to determine coverage. With respect to Medicare and Minnesota Health Care Programs, these policies will apply unless these programs require different coverage.
Medica may use tools developed by third parties, such as MCG Care Guidelines®, to assist in administering health benefits.
Medica UM policies and MCG Care Guidelines are not intended to be used without the independent clinical judgment of a qualified health care provider taking into account the individual circumstances of each member's case. Medica UM policies and MCG Care Guidelines do not constitute the practice of medicine or medical advice. The treating health care providers are solely responsible for diagnosis, treatment, and medical advice.
Members may contact Customer Service at the number listed on their member identification card to discuss their benefits more specifically. Providers may call the Medica Provider Service Center toll-free at 1-800-458-5512.
MCG Care Guidelines® is a registered trademark of MCG Health, LLC.