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Medica Administrative Manual Home > Network Operation and Support Services > Demographic Change

Demographic Changes

Medica has discontinued its process of issuing demographic related amendments to provider contracts. Medica will continue to maintain the record of provider locations listed in
Attachment 1 of each provider participation agreement, but this list will now be maintained electronically.

Medica will continue to send amendments to provider contracts for any changes to the name or federal tax ID listed on the first and last page of the contract document, mergers or acquisitions, rate changes, or other changes that require advance notification.

How to Request a Demographic Change

In order to request a demographic change to a practitioner or clinic or other site:

Use the secure provider demographic-update online tool (PDOT) or the Add/Term/Change form to change or correct clinic demographic data as well as contract or site-level data for Medica products including:

  • 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

You can also submit the appropriate form; either the Add Term Change (ATC) Form or the Minnesota Uniform Credentialing Application. The forms must be completed, signed and dated by the individual authorized by the practitioner or provider to make demographic changes on their behalf. Incomplete forms will be returned without processing.

Submit Medica requests via email or mail to:

Email: MedicaDemoFormSubmis@medica.com

Mail:
Medica Provider Demographics
Route CP412
PO Box 9310
Minneapolis, MN 55440-9310

Minnesota Uniform Practitioner Change Form

The Site Addendum Form is used in conjunction with the Minnesota Uniform Practitioner Change Form when adding or removing practitioners from more than three sites. This form is not acceptable in lieu of the Minnesota Uniform Practitioner Change Form.

The Minnesota Uniform Practitioner Change form is accepted by Medica, Blue Cross and Blue Shield, UCare, HealthPartners and PreferredOne. When using the Minnesota Uniform Practitioner Change form to submit practitioner changes to multiple health plans, please submit your request to the additional health plans per their direction.

It is used to submit the following types of changes:

  • Add a practitioner to an additional practice location
  • Remove a practitioner from a practice location 
  • Add, change or correct basic practitioner demographic data such as:
    • Name
    • SSN
    • Email Address
    • NPI
    • DEA
    • Specialty
    • Languages Spoken Fluently
    • Directory Suppression

Download Minnesota Uniform Practitioner Change Form »

Medica Site Demographic Change Requests

Use the secure, provider demographic-update online tool (PDOT) or the Add/Term/Change form to change or correct clinic demographic data as well as contract or site-level data for Medica, Patient Choice or both products including:

  • A clinic/site to your existing contract
  • Address
  • Admin/billing Number
  • Clinic name
  • Federal identification*
  • Check name*
  • Check address*
  • Clinic e-mail address
  • Fax number
  • Office days and hours
  • Patient appointment phone number

How to Submit a Request

For more about making demographic changes, contact the Provider Service Center at 1-800-458-5512 or see the PDOT User Guide.

For questions regarding clinic demographic changes, please email Medica at MedicaDemoFormSubmis@medica.com. When using the Minnesota Uniform Practitioner Change form to submit practitioner changes to multiple health plans, please submit your request to the additional health plans per their direction.

*Demographic updates including check address and tax ID changes also need to be made as part of the Electronic Payments and Statements (EPS) electronic transaction as well as the Medicalis high-tech imaging system, for those providers enrolled in these programs. The PDOT, EPS and Medicalis systems are separate and need to be updated individually when such changes occur. All of these systems are available through the secure Electronic Transactions login page.

Medica Data Validation

Maintaining current and accurate provider demographic data in our systems and databases is a critical factor in accurate and timely claims payment, as well as the printing and distribution of accurate and current provider directories. 

Validating Provider Data

As part of an ongoing effort to ensure accurate information, Medica is currently working on validating our provider data in partnership with participating providers. Medica will prepare an electronic spreadsheet based on a provider's tax ID number and then send it to the provider. This spreadsheet contains the following information:

  • Instructions
  • A validation report containing all the active providers under a provider's tax ID
  • A list of clinic sites associated with a provider's tax ID, as well as space to update the clinic's hours
  • A sheet to add currently credentialed providers or active non-credentialed providers to another clinic site
  • A sheet to terminate providers from a clinic site
  • A grid explaining the two-digit provider specialty codes (the first two digits of the Medica provider number)

Providers can then verify the information contained in the validation report to ensure that Medica has accurate and current demographic data.

Provider Directories

In order to incorporate any and all necessary changes prior to the next release of the provider directories, we request that providers return the appropriate documents to Medica within four (4) weeks of receiving the data. Any changes received after that time will still be made and will be reflected on medica.com, however, the changes may not appear in the next printed directory for members. 

If no information is received from a provider or clinic as part of this initiative, no changes or updates will be made to the provider data Medica has on file. 

All future changes must be submitted using the appropriate data-change forms that can be accessed above.

Clinics or sites that are interested in participating in this project are invited to contact our Provider Operations team at datavalidation@medica.com. Providers should include contact name, phone number, clinic name and tax ID.

Date: 12/17/2017 2:08:32 AM Version: 4.0.30319.42000 Machine Name: PWIM4-CMSWEB01