By clicking on the link below you will be able to access our directory of Physicians and Providers. If you cannot find what you are looking for, please contact us at any time. Thanks
Do You Want to Report Fraud?
You can report suspected fraudulent activity to Medica HealthCare Plans, anonymously if you wish, by contacting our Compliance Helpline at 1-800-455-4521 or by email at email@example.com
For suspected prescription fraud you can also contact the Express Scripts Fraud Tip Hotline at 1-866-216-7096 or by email at firstname.lastname@example.org
Non-Contracted Physicians and Providers
If you have had a claim denied and wish to file an appeal, please submit your appeal in writing within 60 days of the denial date to Medica HealthCare Plans, Attn. Appeals 4000 Ponce de Leon Blvd., Suite 650, Coral Gables, FL 33146. Please include a signed Waiver of Liability Form and any necessary supporting documentation including medical records. Your appeal cannot be processed without a signed waiver, nor will it be accepted if it is not received within the 60 day filing limit.
If you received a payment from Medica HealthCare Plans and you do not agree with the amount that was paid for a service you provided, you can file a request for reconsideration with Medica HealthCare Plans. We will complete a review of your request and make a determination within 30 days. If no additional payment is made by Medica HealthCare Plans after the review is conducted, you have the option to file a reconsideration request with C2C Solutions, Inc. Instructions for how to submit a reconsideration to C2C as well as the Payment Dispute Decision request form can be found at the C2C website located here.
Last Update: December 10, 2012 at 9:19 pm