Talk to Us
← All payers

Check eligibility on Medica. Payer ID 94265

Medica logo

Check eligibility for free

No account required. Sign a BAA to see plan details, coordination of benefits and more

Bundled codes for maternity are deleted January 1, 2027Get ready for the change >>

Coverage profile

Work Medica across every published route

Use the current payer record to choose the right claim-status, eligibility, portal, phone, or appeals workflow. Substrate only marks routes that are published for this payer.

Claim status

EDI 276/277

The Substrate Claim Status Agent can check clearinghouse claim status for your practice with Medica.

Supported

Eligibility

EDI 270/271

The Substrate Eligibility Agent can verify patient benefits, identify TPAs and carve-outs, and more with Medica.

Available

Portal claim status

Browser automation

The Substrate Claim Status Agent can check claim status via the payer portal for Medica.

Supported

Other aliases

Also known as

  • 07031
  • 10125
  • 11029
  • 14297
  • 1431
  • 8598
  • 94265
  • 94265M
  • 94265MA
  • 94265MC
  • CX026
  • HDVAU
  • MEDIC
  • MEPUB
  • WIMAN
  • Medica (UnitedHealthcare)
  • Medica Dental
  • Medica Medicare Supplement
  • MEDICADENT
  • MEDICA LEGACY

Payer policies

Medica policies

The first 25 of 283 public policies Substrate tracks for Medica, by title. Links open the payer's own document; check its current version before relying on it.

Search all 283 Medica policies by CPT code, keyword or policy number →

Frequently asked questions

Medica payer FAQs

How do I check claim status with Medica?

Providers check Medica via EDI 276/277 when the payer ID is accepted. Substrate automates claim status across 3,500+ payers.

What is the payer ID for Medica?

The primary payer ID for Medica is 94265. The correct routing ID can differ by clearinghouse and transaction, so compare the 837P, 837I, 835, 270, and 276 entries before submitting.

What is the provider portal for Medica?

The provider portal for Medica is https://apps.availity.com/. Available features depend on the payer and your account.

What are the 837 payer IDs for Medica?

The 837P and 837I payer ID for Medica is 94265 via Stedi.

What is the 835 payer ID for Medica?

The 835 payer ID for Medica is 94265 via Stedi.

What is the 270 payer ID for Medica?

The 270 payer IDs for Medica are 94265 via Stedi and 94265 via Availity.

What is the 276 payer ID for Medica?

The 276 payer IDs for Medica are 94265 via Stedi and 94265 via Availity.

What states does Medica operate in?

Medica operates in AZ, IA, KS, MN, MO, ND, NE, OK, SD, WI, and WY.

Resource library

Routing reference

Medica payer IDs and operating states

Use the payer ID listed for the transaction you are submitting. Verify current routing and enrollment requirements with your clearinghouse.

Medica payer name, operating states, and transaction-specific payer IDs
Payer nameMedicaSource: Substrate payer directory · data last changed
Operating statesAZ, IA, KS, MN, MO, ND, NE, OK, SD, WI, WYSource: Substrate payer directory · data last changed
837P professional claims payer IDStedi94265Source: Stedi payer catalog · catalog dated · matched by payer ID
837I institutional claims payer IDStedi94265Source: Stedi payer catalog · catalog dated · matched by payer ID
835 ERA payer IDStedi94265Enrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID
270 eligibility payer IDStedi94265Source: Stedi payer catalog · catalog dated · matched by payer ID
270 eligibility payer IDAvaility94265Source: Availity payer catalog · catalog dated · matched by payer ID
276 claim status payer IDStedi94265Source: Stedi payer catalog · catalog dated · matched by payer ID
276 claim status payer IDAvaility94265Source: Availity payer catalog · catalog dated · matched by payer ID

Routing sources and verification

  • Substrate payer directoryPayer identity, aliases, operating states, and vendor IDs. Data last changed ; checked .Open payer website ↗
  • Stedi payer catalogMatched by payer ID; matched record: Medica. Source dated .PrimaryPayerId is used as the transaction payer ID when the corresponding Stedi support flag is true.Open current Stedi reference ↗
  • Availity payer catalogMatched by payer ID; matched record: MEDICA. Source dated .The attached API workbook supplies 270 and 276 payer IDs only. It does not supply 837P, 837I, or 835 IDs.Open current Availity reference ↗
  • United Clearinghouse payer catalogMatched by payer name; matched record: Medica. The source did not provide a publication date.The attachment supplies payer names and states only; it does not contain transaction-specific payer IDs.Open current United Clearinghouse reference ↗

Clearinghouse payer IDs are transaction-specific and can change. Confirm the current payer list and the member’s ID card before submission.

Payer contact directory

Medica phone and fax numbers

Use the number associated with your task. These contacts were stated in successful eligibility responses and may apply to specific benefits, products, or departments.

Payer phone
(800) 458-5512MEDICA HEALTH PLANS
Medica payer phone and fax directory
Channel and numberPayer NotesDepartmentSpecialties
phone(800) 718-1293Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information
  • UNITEDHEALTHCARE GLOBAL
Health Benefit Plan Coverage
phone(877) 559-2955Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information
  • OPTUMRX
Pharmacy
phone(800) 262-0820Other stated contextBenefit context: Other or Additional Payor
  • BLUE CROSSBLUE SHIELD MN
Health Benefit Plan Coverage
phone(877) 757-4440Other stated contextBenefit context: Active Coverage
  • WELLMED MEDICAL MANAGEMENT INC
Health Benefit Plan Coverage
phone(800) 458-5512Phone menu guide →
  • MEDICA HEALTH PLANS

Phone and fax numbers sourced directly from the payer response

Phone menu guides

Not affiliated with Medica or BCBSA.

Confirm routing with your clearinghouse. Report an error

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

This website uses cookies to ensure you get the best experience on our website. Learn more