Not all claims for medical services incurred by patients who access the Midlands Choice network are to be sent to Midlands Choice. If the patient has coverage through payers such as Cigna, Medica, HealthPartners, QualChoice and others, the claim should be submitted directly to the payer using the address or payer ID on the member’s ID card. Claims for other members are to be sent to Midlands Choice for repricing; Midlands Choice will then forward the claim to the payer for adjudication.
The most efficient way to determine where to submit a medical claim on behalf of a patient that uses the Midlands Choice network is to look at the patient’s member identification card issued by his or her insurance carrier. The ID card displays the claim address, as well as the payer ID to be used when submitting claims electronically. Registered users of the MidlandsChoice.com secured tools can also locate the claim submission address by performing a search on the Employer/Group Lookup screen.
Claims that are sent to Midlands Choice in error will be returned to the provider with a message stating that the claims should be submitted to the payer.