How to contact us, Medica HealthCare supplement - 2021 UnitedHealthcare Administrative Guide

Questions or comments

Questions or comments about this manual should be emailed to Network Management Services (NMS) at pcp-NetworkManagementServices@uhcsouthflorida.com, or submitted by mail to:

Medica HealthCare
Network Management Services 9100 South Dadeland Blvd.
Suite 1250
Miami, FL 33156-6420

Contact us table

Where to go: 

  • EDI: Transactions 278 and 278N 
  • Online: UHCprovider.com/paan
  • Phone: 1-866-273-9444, 8 a.m. – 8 p.m. local time, 7 days a week

What you can do there:

  • Initiate requests for notifications and authorizations electronically
  • Submit notifications, prior authorizations, referrals, admissions, and discharge planning
  • Submit after-hours or weekend emergencies, notifications or hospital admissions

Where to go: 

Outpatient notifications

  • Phone: 1-877-299-7213
  • Fax: 1-866-322-7276

Inpatient notifications

  • Phone: 1-877-490-8982
  • Fax: 1-877-757-8885

 

Where to go: 

  • Online: UHCprovider.com/Link 
  • Phone: 1-800-348-5548, 8 a.m. – 8 p.m. local time, 7 days a week

What you can do there:

  • Verify eligibility and benefits of enrolled members

Where to go: 

  • Online: UHCprovider.com/Link
  • Phone: 1-866-273-9444, 8 a.m. – 8 p.m. local time, 7 days a week
  • Mail:     
    Medica HealthCare Plans, Inc.
    P.O. Box 30448,
    Salt Lake City, UT 84130-0448

What you can do there:

  • Submit or review claims, encounters, inquiries, status, or review requests
  • Check claims, eligibility, benefits

Where to go:

WellMed Claims
P.O. Box 400066
San Antonio, TX 78229

What you can do there:

  • Use Payer ID WELM2.

Where to go: 

  • Phone: 1-800-845-6592

What you can do there:

  • Obtain assistance with password or technical support issues
 

Where to go: 

What you can do there:

  • Ask questions related to overpayments

Where to go: 

What you can do there:

  • Access list of participating Physical Therapist providers in our directory

Where to go:

  • Phone: 1-800-963-6495, Monday–Friday, 9 a.m. – 5 p.m.
  • Fax:  1-844-897-6352

What you can do there:

  • Update or complete credentialing, re- credentialing, document changes, or recent hires or terminations in your practice or facility

Where to go: 

  • Phone: 1-800-819-0751

What you can do there:

  • Register for these services
  • On call 24 hours a day
  • You may also call Utilization Management or Network Management
Where to Go: 
What You Can Do There:
  • Information and registration for electronic payment services

Where to go: 

What  you can do there:

  • Information and registration for electronic payment services

Where to go: 

  • Phone: 1-800-407-9069, 8 a.m. – 8 p.m. local time, 7 days a week

What you can do there:

  • Report concerns related to fraud, waste or abuse

Where to go: 

MA and MA Prescription Drug (MAPD) Plans:

Medica HealthCare, Inc.
P.O. Box 6106
Mail Stop CA
124-0157 Cypress, CA 90630

Medicare and Retirement Prescription Drug Plans (PDP):

Medica HealthCare, Inc.
P.O. Box 6106
Mail Stop CA 124-0197
Cypress, CA 90630

What you can do there:

  • Obtain information about filing a grievance or appeal on behalf of a member, status inquiries, or requests for forms

Where to go: 

  • Phone: 305-883-2940

What you can do there:

  • Arrange for services
  • On-call 24 hours a day
  • You may also call Utilization Management or Network Management

Where to go: 

  • Phone: 1-800-407-9069, 8 a.m. – 8 p.m. local time, 7 days a week
  • Fax:  1-800-517-6924

What you can do there:

  • Assist our members with questions, help locate specialists, and perform other related functions
  • Also printed on the member’s ID card

Where to go: 

What you can do there:

  • Ask questions regarding your Agreement, in- servicing and follow-up and outreaches
  • Report demographic changes such as TIN changes, care provider terminations and additions
  • Submit informal complaints
  • Find or request forms or other materials
  • Panel status

Where to go: 

What you can do there:

  • Verify pharmacy benefits and eligibility, adjudications, or authorizations

Where to go: 

What you can do there:

  • Report incidents involving all privacy issues (potential breaches of PHI or PII) immediately to our Risk Manager

Where to go: 

  • Phone: 1-855-575-0293

What you can do there:

  • Speak to a nurse to triage to emergency or urgent care, or to refer members to their primary care physician

Where to go: 

  • Online: providerexpress.com
    Licensed clinicians available 24 hours.
    Member Services – 24 hours.
  • Phone:
    1-800-985-2596 No DSNP
    1-800-496-5841 DSNP and iSNP

What you can do there:

  • Obtain information about behavioral health and substance use services for all members
  • Access a list of behavioral health practitioners and care providers in the provider directory

 

Where to go: 

What you can do there:

  • Access a list of Solstice dental providers in the provider directory

Where to go: 

 

Where to go: 

  • Phone: 1-877-670-8432, Monday–Friday, 9 a.m. – 5 p.m.

 

LabCorp

Where to go: 

  • Online: labcorp.com
  • Phone: 1-855-277-8669 Automated Line
  • Phone: 1-800-1-877-7831 Live Scheduling

What you can do there:

  • Find information on locations, to make an appointment, and to order lab tests and view results

 

QUEST

Where to go: 

Where to go: 

What you can do there:

  • Obtain mail-order medications

Where to go: 

  • Phone: 1-877-670-8432, Monday–Friday, 9 a.m. – 5 p.m.

What you can do there:

  • Access a list of podiatrists in our provider directory

Where to go: 

  • Phone: 1-888-774-7772,  Monday–Friday, 9 a.m. – 5 p.m

Where to go: 

  • Phone: 1-877-670-8432, Monday–Friday, 9 a.m. – 5 p.m.

What you can do there:

  • Access a list of vision providers in our provider directory

WellMed Medical Management, Inc. (WellMed)

For members who belong to a Primary Care Physician (PCP) in the Medica HealthCare Network, their utilization management (UM) and claim services are handled through WellMed. To identify these members, refer to the member ID card. The Payer ID is listed as WELM2 and “WellMed” is listed in the lower right corner of the card.

Claims Processing for WellMed Members

Submit claims electronically to Payer ID WELM2. If mailing, send to: WellMed Claims
P.O. Box 400066
San Antonio, TX 78229.