Inspire by Medica

Inspire by Medica is an accountable care system product being offered in the individual and family business(IFB) market in Iowa. The Inspire network features UnityPoint Health providers. No referral is needed to see in-network specialists. Members do not have benefits for out-of-network providers. To verify which providers are included in this product's network, see the provider directory on Medica.com. If you have a direct agreement with Medica, the Midlands Choice rates would not apply.

Identification Card Example

Availability

• For individual and family Business(IFB) members
• Service area includes 25 counties in Iowa: Benton, Black Hawk, Boone, Bremer, Buchanan, Butler, Cedar, Clayton, Dallas, Delaware, Dubuque, Fayette, Greene, Grundy, Iowa, Jackson, Jones, Linn, Marshall, Muscatine, Polk, Scott, Tama, Warren and Woodbury

Network

• UnityPoint Health
• UnityPoint Clinic
• Broadlawns Medical Center
• Delaware County Memorial Hospital
• Grand River Medical Group
• Greene County Medical Center
• Grinnell Regional Medical Center
• Jones Regional Medical Center
• Peoples Memorial Hospital
• Virginia Gay Hospital Inc.
• This product does not have a national travel network

Specialty Networks

• Chiropractic: Optum Physical Health
• Behavioral Health: Medica Behavioral Health (MBH), administered by Optum
• Transplants: Kidney - UnityPoint/Iowa Methodist, Optum Transplant for all others
• Pharmacy: Express Scripts
• Specialty Pharmacy: Accredo

Member Benefits

• Exclusive Provider Network (EPO) product with no out-of-network benefits
• Comprehensive coverage for preventive and other care needs
• All essential health benefits covered
• Complex Specialty Care program allows patients to receive care at University of Iowa and Mayo Clinic for transplants, certain rare cancers and complex medical conditions

Claim Submission

Medical claims should be submitted to:
Medica
PO Box 21051
Eagan, MN  55121-0051
Electronic pay ID: 12422

Medica Behavioral Health claims should be submitted to:
Medica
PO Box 30757
Salt Lake City, UT 84130
Electronic pay ID: 87726

Medica Chiropractic claims should be submitted to:
Medica
PO Box 212
Minneapolis, MN 55440-0212
Electronic pay ID: 41161

Empower by Medica

Empower by Medica is an accountable care system product being offered in the Individual and Family Business (IFB) market in Johnson county of Iowa. The network features University of Iowa Health Care providers. No referral is needed to see in-network specialists. Members do not have benefits for out-of-network providers. To verify which providers are included in this product's network, see the provider directory on Medica.com. If you have a direct agreement with Medica, the Midlands Choice rates would not apply.

Identification Card Example

Availability

• For individual and family Business (IFB) members
• Service area is Johnson county of Iowa

Network

• University of Iowa Hospitals & Clinics
• University of Iowa Stead Family Children's Hospital
• University of Iowa Roy J. and Lucille A. Carver College of Medicine
• University of Iowa Physicians
• This product does not have a national travel network

Specialty Networks

• Chiropractic: Optum Physical Health
• Behavioral Health: ACO and local providers
• Transplants: Optum Transplant
• Pharmacy: Express Scripts
• Specialty Pharmacy: University of Iowa Health Care (UIHC) & Accredo

Member Benefits

• Comprehensive coverage for preventive and other care needs
• All essential health benefits covered
• Complex Specialty Care program allows patients to receive care at University of Iowa and Mayo Clinic for transplants, certain rare cancers and complex medical conditions

Claim Submission

Medical claims should be submitted to:
Medica
PO Box 21051
Eagan, MN  55121-0051
Electronic pay ID: 12422

Medica Behavioral Health claims should be submitted to:
Medica
PO Box 30757
Salt Lake City, UT 84130
Electronic pay ID: 87726

Medica Chiropractic claims should be submitted to:
Medica
PO Box 212
Minneapolis, MN 55440-0212
Electronic pay ID: 41161

Medica Choice National

Medica Choice National provides access to a large, national network with thousands of providers, plus the freedom to see any network provider at any time, including direct access to specialists. Medica Choice National provides a single health plan for employers with employees located both locally and across the country. It is available to employers headquartered in Nebraska and Iowa. If you have a direct agreement with Medica, the Midlands Choice rates would not apply.

Identification Card Example

Availability

• Available for both self-insured and fully insured employer groups
• Allows members open access to providers across the nation
• Network comprises Medica Choice National, the Midlands Choice network in Nebraska and Iowa, and the First Health network outside of Nebraska and Iowa

Specialty Networks

• Chiropractic: Optum Physical Health
• Behavioral Health: Medica Behavioral Health (MBH), administered by Optum
• Transplants: Optum
• Pharmacy: Express Scripts

Member Benefits

• Members choose from any doctor, clinic or facility in the large Medica Choice National network. To get the highest network benefits, member should see network providers.
• Members can see any primary or specialty care provider in the Medica Choice National network without a referral. While members don't need a referral to see a specialist, it's best if they do work closely with a primary care doctor to coordinate health care needs.
• Medica Choice National's nationwide network means that members have access to in-network care when they're away from home.

Claim Submission

Medical claims should be submitted to:
Medica
PO Box 211435
Eagan, MN  55121
Electronic pay ID: 71890

Medica Behavioral Health claims should be submitted to:
Medica
PO Box 30757
Salt Lake City, UT 84130
Electronic pay ID: 87726

Medica Chiropractic claims should be submitted to:
Medica
PO Box 212
Minneapolis, MN 55440-0212
Electronic pay ID: 41161

Medica Administrative Resources

The Medica Administrative Manual is a resource for physicians and healthcare providers that provides accurate and timely information about Medica products, programs, policies and procedures. The manual contains specific Qualified Health Plan(QHP) requirements, including the QHP requirements for Indian Health Care Providers. Midlands Choice providers shall comply with the Medica Administrative Manual when providing services to Medica members.

The manual may be found on the Medica.com website in the “For Providers” section under Administrative Resources or by clicking on the links below:

Medica Administrative Manual

Qualified Health Plan(QHP) Requirements

Product Information