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Providers

Welcome to the Medica Provider Network

 provider

Now that you've joined our network, here are the top two actions you'll want to complete:

 

Number 1Register for our secure Provider Portal

You can use the secure Provider Portal to access all our electronic transaction tools including verifying patient eligibility, checking claim status, and signing up for electronic payments and statements (EPS).

Register for a secure Provider Portal account >


Number 2Sign up to receive news and alerts

Our monthly e-newsletter, Connections, is how we inform you of policy changes, new resources and new products. And if there's anything urgent to share, we'll let you know with a timely provider alert email.

Sign up for email news and alerts >



Getting to Know Medica

Learning the ropes with an insurer can be challenging. Here are the top questions our new providers ask.

In our Claim Tools area, you can find sample claim forms, a breakdown of how and where specific types of claims should be submitted and learn more about electronic claim submission.

Claim Tools 

Our secure Provider Portal allows you to track claim status — that's why it's so important to sign up!

Provider Portal Login 

To make an eligibility inquiry, log in to our secure Provider Portal. It's as simple as filling out a form. Eligibility information is available for 12 months in the past or up to the end of the current month.

Provider Portal Login

Our complete coverage, reimbursement and utilization management policies are available on our website in the Policies and Guidelines section. 

Policies and Guidelines

Pharmacy information, including formulary and prior authorization requirements, is available on our website.

We break it down by type of member — including RX Group# — to make it easy to find what you're looking for.

Pharmacy

We offer live webinars and self-directed e-training opportunities to help you make the most of working with Medica. Our current training schedule and our e-trainings are available in the Training section of our website.

Training from Medica Provider College

Yes! You can review your current demographic information on our Physician Search tool in the secure Provider Portal.

Provider Portal Login

For most providers, incorrect or incomplete demographic information can be changed electronically via our provider demographic-update online tool (PDOT). We have complete information on verifying and updating demographic information on our website. If you need help or have questions, contact our Provider Service Center. 

Demographic Changes

We maintain fact sheets that explain each of our products in detail including:

  • Service area counties
  • Sample ID card images
  • Network details
  • Group numbers
  • ... And more!

Product Information

Our administrative manual offers a comprehensive collection of information on our policies and procedures, including:

  • Administrative policies and procedures

  • Billing and reimbursement

  • Fraud and abuse

  • Glossary of terms

  • Health management and quality improvement

  • Member care
  • Network operation and support services

  • Pharmacy services

  • Product portfolio

  • Protocols

  • Regulatory reporting

  • Special contracting requirements
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    Administrative Manual



    Provider Service Center

    1-800-458-5512

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

    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
  •  

    Not finding what you need? View other Medica contact points



    The information on this page is intended to serve as a reference to providers who have recently reached an agreement with Medica to participate in its provider networks. This page does not constitute, and must not be interpreted as, a legal contract between Medica and any individual or entity. Only the mutual negotiation and signature of a written contract will obligate Medica in accordance with the terms and conditions contained in that contract. To request a new provider contract with Medica, please refer to information about Joining the Medica Provider Network.


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