Medica

Summary

Medica is a regional health plan, part of Medica Health Plans, offering dental, medical, and vision coverage operating in 9 states. Claims route under payer ID 94265, with 14 alternate IDs in use across clearinghouses. Provider enrollment typically takes 45-90 days, with applications through Medica Provider Portal, and CAQH is used for credentialing data. Through clearinghouses it supports eligibility checks, claim status inquiries, professional claims, institutional claims, dental claims, and electronic remittance (ERA); ERA enrollment is required and takes several weeks.

At a glance

Payer ID

94265Also seen as 07031, 10125, 11029, 14297, 1431, 8598 and 8 more

Also known as

Medica (UnitedHealthcare), Medica Dental, Medica Medicare Supplement

Uses CAQH

YesApplication route: CAQH application only

Service area

MN, ND, SD, WI, NE, IA, KS, MO, OK

Clearinghouse transaction setup

Which EDI transactions this payer supports, and how long clearinghouse enrollment typically takes when it is required.

Common questions

What is the payer ID for Medica?

The payer ID for Medica is 94265. Alternate IDs seen across clearinghouses include 07031, 10125, 11029, 14297.

How long does Medica provider enrollment take?

Medica provider enrollment typically takes 45-90 days from application to effective date. Timelines vary by state, plan, and how complete the application is.

Does Medica require CAQH?

Yes. Medica uses CAQH for credentialing data, so keep the provider's CAQH profile current and attested before applying.

Does Medica require ERA enrollment?

Yes. Medica requires a separate ERA (835) enrollment before electronic remittances flow, and setup typically takes several weeks.

What states does Medica cover?

Medica operates in MN, ND, SD, WI, NE, IA, KS, MO, OK. Coverage can differ by plan and product line, so confirm the specific plan before you file.

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