Medica
Also covers / subsidiaries: Medica Health Plans
Core Payer & Clearinghouse Profile
Electronic Payer ID
10125
94265 routes to Optum; Medica uses multiple payer IDs by product (e.g. 71890, 12422, MEDM1) via Availity. Confirm per member/product.
Timely Filing Limit (TFL)
180 days from DOS (date of discharge for inpatient); some products up to 18 months
Appeal Window
Generally 12 months from the claim processed date to submit an initial adjustment/appeal
Clearinghouse Gateway
Availity (most payer IDs); Optum for payer ID 94265
Provider Services
800-458-5512
Claims Fax
Varies — confirm via portal / clearinghouse
Claims Address
Varies — confirm via portal / clearinghouse
Provider Portal
https://partner.medica.com/providers
Minnesota-based, multi-state (MN/WI/IA/ND/SD/NE/KS/MO and others); also Medicare/Medicaid; now administers Dean Health Plan claims.
National EDI Clearinghouse Capabilities
Direct ANSI X12 electronic transaction support verified for Medica.
Associated Clearinghouse Payer IDs
National clearinghouse networks maintain dedicated routing IDs for specific transaction lines or subsidiaries under Medica.
| Clearinghouse Name | Electronic Payer ID | Status | Enrollment | Supported Services |
|---|---|---|---|---|
| Medica | 10125 | Non-Par | None | 837P837I270/271276/277Dental |
| Medica | 94265 | Non-Par | Required | 837P837I835 ERA |
| Medica Health Plans | 11029 | Par | None | 837P837I270/271276/277Dental |
Resolution Tools for Medica Claims
Values vary by plan, line of business, and provider agreement. Confirm in the payer portal or with your clearinghouse gateway before submitting electronic claims.
Tired of Chasing Medica Denials & Delayed Payments?
Aethera's billing specialists work Medica every day — handling EDI clearinghouse rejects, prior authorizations, payment posting, and 30-day AR aging recovery.