Common reasons why original claim submissions will be returned include, but are not limited to:
• Member's Medica identification number is missing or invalid for date of service.
• Participating provider’s NPI is missing or invalid.
• Referring physician's name or NPI is missing or invalid when required.
• Subscriber/member is not valid.
• Demographic information on claim does not match what Medica has on file.
• There is missing or invalid information in any of the required applicable fields designated on the sample Send-back Form below.
Please Note: "Send-back" (returned) claims will include a request that the participating provider RESUBMIT the bill as an original claim. Medica does not input or track claims that have been returned to a provider due to improper claim information. Medica maintains no information about send-back claims in its system.
Questions regarding claim send-backs should be directed to the Provider Service Center at 1 (800) 458-5512, which can clarify the information needed to resubmit a claim for processing.