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Now that you've joined our network, here are the top two actions you'll want to complete:
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).
To get started on your Provider Portal registration, please contact the Provider Service Center at 1-800-458-5512.
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.
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.
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.
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:
Product Information
Our administrative manual offers a comprehensive collection of information on our policies and procedures, including:
Administrative Manual
7 a.m. – 5 p.m. Monday – Friday, Closed Mondays from 8 – 9 a.m.
Our highly-trained representatives in the Provider Service Center can assist with the following inquiries and more:
Not finding what you need? View Medica contacts by category
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.