Select the appropriate Payer ID below to view Medica claim submission and product guidelines for each plan.
Payer ID: 94265 +
| Address for Claims and Claim Appeals | Medica PO Box 30990 Salt Lake City, UT 84130-0990 |
| Attachment/Appeal Fax# | 1-801-994-1076 Claim Adjustment or Appeal Request Form (DOC) |
| Electronic Appeal Submission | Log in to SympliSend |
| Claim Numbers | 5 digit groups: Claim numbers are 10 digits (CMS-1500) and 11 digits (UB-04); 6 digit groups: Claim numbers are 12 digits |
| Electronic Data Interchange (EDI) | Optum Intelligent EDI |
| Electronic Funds Transfer (EFT) Payments | Optum Health Financial Services 1-866-842-3278, option 5 |
| Prior Authorization Submission | Prior Authorization submitted via email and/or fax number provided on the corresponding form |
| Inpatient Notification Submission | Medica.com Provider Portal/Admission Notification Inpatient Admission– Notification Guidelines |
| Referral Submission | Medica.com Provider Portal/Administrative Referral Entry for referral-based products |
| Clinical Guidelines | Policies and Guidelines on Medica.com |
| Provider Service Center | 1-800-458-5512 |
| Pharmacy | BIN/PCN/Group # vary by product– see member's ID card |
| Chiropractic Care | Medica Benefits/Claims: Medica– 1-800-458-5512 Eligible Chiropractic Codes for Commercial and Individual Plans Only |
| Behavioral Health | Medica Behavioral Health (MBH): 1-800-848-8327 Medica Behavioral Health Payer ID: 87726 |
| Secure Provider Portal | Medica.com - Electronic Transactions |
Product Fact Sheets
Clear Value With Medica
Essentia Choice Care with Medica (Commercial)
Medica Choice Passport
Medica CompleteHealth
Medica Elect and Medica Essential
Medica Focus
Park Nicollet First with Medica
Ridgeview Community Network powered by Medica
VantagePlus with Medica
Medica AccessAbility Solution / Special Needs Basic Care (SNBC)
Medica AccessAbility Solution Enhanced / Special Needs Basic Care (SNBC SNP)
Medica Dual Solution/Minnesota Senior Health Options (MSHO)
Medica Choice Care MSC+/Minnesota Senior Care Plus (MSC+)
Medica Prime Solution
Medica Select Solution
Medica Signature Solution
University of Minnesota
Payer ID: 12422 +
| Address for Claims and Claim Appeals | Medica Individual & Family Business Note: When submitting claims under this payer ID, use only the 10-digit member ID. If you include the 2-digit suffix for the member, the claim will reject as “member not on file” |
| Attachment/Appeal Fax# | 1-952-992-1427 Claim Adjustment or Appeal Request Form (DOC) |
| Electronic Appeal Submission | Log in to Medica Provider Portal |
| Claim Numbers | 11 digits |
| Electronic Data Interchange (EDI) | Availity Client Services: 1-800-282-4548 Note: When submitting claims under this payer ID, use only the 10-digit member ID. If you include the 2-digit suffix for the member, the claim will reject as “invalid eligibility for member” |
| Electronic Funds Transfer (EFT) Payments | InstaMed: 1-866-945-7990 |
| Prior Authorization Submission | Prior Authorization submitted via email and/or fax number provided on the corresponding form |
| Inpatient Notification Submission | Fill out the Inpatient Notification Form on Medica.com Inpatient Admission– Notification Guidelines |
| Clinical Guidelines | Policies and Guidelines on Medica.com |
| Provider Service Center | 1-800-458-5512 |
| Pharmacy | ExpressScripts (ESI). BIN/PCN/Group # vary by product — see member's ID card |
| Chiropractic Care | Optum Chiropractic Payer ID: 41161 Benefits/Claims– Medica: 1-800-458-5512 Authorizations/treatment plans are not required Eligible Chiropractic Codes for Commercial and Individual Plans Only |
| Behavioral Health | Medica Behavioral Health (MBH): 1-800-848-8327 Medica Behavioral Health Payer ID: 87726 |
| Secure Provider Portal | Medica.com– Electronic Transactions |
Product Fact Sheets
Altru Prime by Medica
Balance by Medica
Bold by M Health Fairview
Elevate by Medica
Empower by Medica
Engage by Medica
Essentia Choice Care with Medica (Individual and Family Business)
Harmony by Medica
Inspire by Medica
Medica Applause
Medica ConnectMedica Direct HSA
Medica Direct Value
Medica Encore
Medica Individual Choice
Medica Insure
Medica Pinnacle
Medica Quest
Medica Solo
Medica Symphony HSA
Medica with CHI Health
Medica with MU HealthCare
North Memorial Acclaim by Medica
Ridgeview Distinct by Medica
Select by Medica
Payer ID: 71890 +
| Address for Claims and Claim Appeals (paper submission and correspondence) | Medica Note: When submitting claims under this payer ID, use only the 10-digit member ID. If you include the 2-digit suffix for the member, the claim will reject as “member not on file” |
| Attachment/Appeal Fax# | 952-992-3024 Claim Adjustment or Appeal Request Form (DOC) |
| Electronic Appeal Submission | Log in to Medica Provider Portal. |
| Claim Numbers | 13 digits |
| Electronic Data Interchange (EDI) | Availity Client Services: 1-800-282-4548 Note: When submitting claims under this payer ID, use only the 10-digit member ID. If you include the 2-digit suffix for the member, the claim will reject as “invalid eligibility for member” |
| Electronic Funds Transfer (EFT) Payments | InstaMed: 1-866-945-7990 |
| Prior AuthorizationSubmission | Prior authorization submitted via email and/or fax number provided on thecorresponding form |
| Inpatient Notification Submission | Fill out the Inpatient Notification Form on Medica.com Inpatient Admission– Notification Guidelines |
| Clinical Guidelines | Policies and Guidelines on Medica.com |
| Provider Service Center | 1-800-458-5512 |
| Pharmacy | Varies by product – see member's ID card |
| Chiropractic Care | Varies by product – see member's ID card Note: Effective 1/1/2024, chiropractic claims for Mayo and Medica Health Plan Solutions products in MN/WI should be submitted to EDI# LNDMK or Fulcrum Health, Inc. P.O. Box 981808, El Paso, TX 79998-1808. This information is not reflected on the ID Card. Questions? Contact Fulcrum at 1 (877) 886-4941, option 9, or by e-mail at [emailprotected]. |
| Behavioral Health | Any provider within the available networks (see applicable provider fact sheet below for directory). |
| Secure Provider Portal | Medica.com– Electronic Transactions |
Product Fact Sheets
Mayo Medical Plan
Medica Choice National
Medica with CHI Health Fact Sheet (Accountable Care System Product)
Medica Health Plan Solutions
Payer ID: 53589 – AZ +
| Address for Claims and Claim Appeals (paper submission and correspondence) | Medica BCBS AZ providers submit to payer ID 53589 Mayo Clinic providers submit to payer ID 71890 |
| Attachment/Appeal Fax# | 952-992-3024 Claim Adjustment or Appeal Request Form (DOC) |
| Claim Numbers | 13 digits |
| Electronic Appeal Submission | Log in to Medica Provider Portal. |
| Electronic Data Interchange (EDI) | BCBS AZ providers submit to payer ID 53589 |
| Electronic Funds Transfer (EFT) Payments | InstaMed: 1-866-945-7990 |
| Prior Authorization Submission | Prior Authorization submitted via email and/or fax number provided on thecorresponding form |
| Inpatient Notification Submission | Fill out the Inpatient Notification Form on Medica.com Inpatient Admission– Notification Guidelines |
| Clinical Guidelines | Policies and Guidelines on Medica.com |
| Provider Service Center | 1-800-458-5512 |
| Pharmacy | Alluma 1-833-789-5310 BIN/PCN/Group # vary by product– seesee member's ID card |
| Chiropractic Care | BCBS AZ provider network Payer ID: 53589 |
| Behavioral Health | BCBS AZ provider network Payer ID: 53589 |
| Secure Provider Portal | Medica.com– Electronic Transactions |
Product Fact Sheet
Mayo Medical Plan AZ
Payer ID: 88090 – FL +
| Claim Address (paper submission and correspondence) | Zelis/Medica Zelis providers submit to payer ID 88090 Mayo Clinic providers submit to payer ID 71890 |
| Address for Claim Appeals | Medica |
| Attachment/Appeal Fax# | 952-992-3024 Claim Adjustment or Appeal Request Form (DOC) |
| Electronic Appeal Submission | Log in to Medica Provider Portal. |
| Claim Numbers | 13 digits |
| Electronic Data Interchange (EDI) | Zelis providers submit to payer ID 88090 |
| Electronic Funds Transfer (EFT) Payments | InstaMed: 1-866-945-7990 |
| Prior Authorization Submission | Prior Authorization submitted via email and/or fax number provided on the corresponding form |
| Inpatient Notification Submission | Fill out the Inpatient Notification Formon Medica.com Inpatient Admission– Notification Guidelines |
| Clinical Guidelines | Policies and Guidelines on Medica.com |
| Provider Service Center | 1-800-458-5512 |
| Pharmacy | Alluma 1-833-789-5310 BIN/PCN/Group # vary by product – see member's ID card |
| Chiropractic Care | Zelis provider network Zelis/Medica Payer ID: 88090 |
| Behavioral Health | Any available provider within the Zelis network Zelis/Medica Payer ID: 88090 |
| Secure Provider Portal | Medica.com– Electronic Transactions |
Product Fact Sheet
Mayo Medical Plan FL
Payer ID: MEDM1 +
| Address for Claims and Claim Appeals | Medica Government Programs Note: When submitting claims under this payer ID, use only the 10-digit member ID. If you include the 2-digit suffix for the member, the claim will reject as “member not on file” |
| Attachment/Appeal Fax# | 952-992-3899 Claim Adjustment or Appeal Request Form (DOC) |
| Electronic Appeal Submission | Log in to Medica Provider Portal. |
| Claim Numbers | 13 digits |
| Electronic Data Interchange (EDI) | Availity Client Services: 1-800-282-4548 Note: When submitting claims under this payer ID, use only the 10-digit member ID. If you include the 2-digit suffix for the member, the claim will reject as “invalid eligibility for member” |
| Electronic Funds Transfer (EFT) Payments | InstaMed: 1-866-945-7990 |
| Prior Authorization Submission | Prior Authorization submitted via email and/or fax number provided on the corresponding form |
| Inpatient Notification Submission | Fill out the Inpatient Notification Formon Medica.com Inpatient Admission– Notification Guidelines |
| Clinical Guidelines | Policies and Guidelines on Medica.com |
| Provider Service Center | 1-800-458-5512 |
| Pharmacy | Medicare Advantage Solution: Rx Bin: 003858 Medicaid Families and Children: |
| Chiropractic Care | Benefits/Claims – Medica: 1-800-458-5512 Authorizations – Optum: 1-800-873-4575 Optum Chiropractic Payer ID: 41161 |
| Behavioral Health | Medica Behavioral Health (MBH): 1-800-848-8327 Medica Behavioral Health Payer ID: 87726 |
| Dental (Medicaid Families and Children only) | Delta Dental PO Box 9120 Farmington Hills, MI48333-9120 Payer ID: 07000 |
| Secure Provider Portal | Medica.com– Electronic Transactions |
Product Fact Sheets
Medica Advantage Solution HMO Fact Sheet
Medica Advantage Solution HMO-POS Fact Sheet
Medica Advantage Solution and Medica Advantage PPO Fact Sheet
Payer ID: 41822 +
| Address for Claims and Claim Appeals | Medica |
| Attachment/Appeal Fax# | Fax to 952-992-2836 or E-Mail to [emailprotected] Utilization Management and Clinical Appeals |
| Electronic Appeal Submission | Dean Health Plan: providerauth.deancare.com Prevea360: providerauth.prevea360.com Medica (formerly known as WellFirst): providerauth.mo-central.medica.com |
| Claim Numbers | Claim numbers are 13 digits |
| Electronic Data Interchange (EDI) | Availity Client Services: 1-800-282-4548 |
| Electronic Funds Transfer (EFT) Payments | InstaMed: 1-866-945-7990 |
| Prior Authorization Submission | Prior authorization submission details can be found here: |
| Inpatient Notification Submission | Does not apply to payer 41822 |
| Referral Submission | Does not apply to payer 41822 |
| Clinical Guidelines | Dean Health Plan: www.deancare.com/providers/medical-management |
| Provider Service Center | 1-800-458-5512 |
| Pharmacy | Navitus: 866-333-2757 |
| Chiropractic Care | Medica Benefits/Claims/Authorizations: Medica – 1-800-458-5512 |
| Behavioral Health | Medica Benefits/Claims/Authorizations: Medica – 1-800-458-5512 |
Product Fact Sheets
Dean Health Plan Focus EPO Fact Sheet
Dean Health Plan HMO Fact Sheet
Medica (formerly WellFirst Health) Fact Sheet
Prevea360 Fact Sheet
