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Medica Claim Submission and Product Guidelines
Webfrom the primary payer in the Other Subscriber Information fields. • Payer paid, total non-covered, and remaining patient liability amountsfrom the primary payer at both the claim and service line levels, if available. • Claim adjustment reason codes (may require converting the primary payer's EOP into the standard coding used in an ERA). WebWPS Health Plan P.O. Box 21352 Eagan, MN 55121 FAX: 608-327-6332 (do not include cover sheet) WebDenver Health Medical Plan 0000001321: Deseret Mutual (DMBA) 10578 Devoted Health 12268: Director’s Guild 10077 District No. 9, I. A. of M. & A W. Welfare Trust 11098: … ttsh location