Coverage profile
How Substrate can help you with Medica
Substrate can help practices and billers with the following claims tasks for Medica.
Claim status
EDI 276/277The Substrate Claim Status Agent can check clearinghouse claim status for your practice with Medica.
Eligibility
EDI 270/271The Substrate Eligibility Agent can verify patient benefits, identify TPAs and carve-outs, and more with Medica.
Portal claim status
Browser automationThe Substrate Claim Status Agent can check claim status via the payer portal for Medica.
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.
Can I automate Medica portal follow-up?
Yes — portal retrieval is required when 276/277 is missing or stale. See payer portal automation and learn why 276/277 is not enough.
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 and 94265M via Availity.
What is the 276 payer ID for Medica?
The 276 payer IDs for Medica are 94265 via Stedi and 94265 and 94265M via Availity.
What states does Medica operate in?
Medica operates in AZ, IA, KS, MN, MO, ND, NE, OK, SD, WI, and WY.
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.
| Payer name | Medica |
|---|---|
| Operating states | AZ, IA, KS, MN, MO, ND, NE, OK, SD, WI, WY |
| 837P professional claims payer IDStedi | 94265 |
| 837I institutional claims payer IDStedi | 94265 |
| 835 ERA payer IDStedi | 94265Enrollment required |
| 270 eligibility payer IDStedi | 94265 |
| 270 eligibility payer IDAvaility | 9426594265M |
| 276 claim status payer IDStedi | 94265 |
| 276 claim status payer IDAvaility | 9426594265M |
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
| Channel and number | Payer Notes | Department | Specialties |
|---|---|---|---|
| phone(800) 718-1293 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Health Benefit Plan Coverage |
| phone(877) 559-2955 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Pharmacy |
| phone(800) 262-0820 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(877) 757-4440 | Other stated contextBenefit context: Active Coverage |
| Health Benefit Plan Coverage |
| phone(800) 458-5512 |
|
Phone and fax numbers sourced directly from the payer response
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