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Regional Carrier · Minnetonka, Minnesota
Optum Facility Credentialing & Network Participation
Medica is a nonprofit health plan serving over 1.5 million members across the Upper Midwest. They focus on affordable healthcare solutions with strong presence in both commercial and government programs.
Medica payer facts
Market context
Strong regional presence in Minnesota with 20% market share, expanding across Upper Midwest markets.
Payer guide
Medica provides comprehensive behavioral health benefits through Medica Behavioral Health (MBH), administered by Optum, with focus on integrated care, prevention, and community-based services across their Midwest markets.
Behavioral Health Manager
Optum
All treatment settings accepted by Medica
What sets Medica apart
Required credentials for network participation
Prior Authorization
Medical Necessity Criteria
Uses nationally recognized criteria through Optum - likely InterQual or MCG for mental health, ASAM for substance use
Payment and billing information
Network opportunities
Adolescent residential treatment centers, eating disorder specialty programs, co-occurring disorder treatment facilities, rural area coverage, specialized trauma programs
High-demand service areas and locations
Coverage area
5 states nationwide
Corporate Headquarters
Minnetonka, Minnesota
Continue learning
Provider guide
Learn what insurance credentialing is, why it matters, and how to navigate the process to get in-network.
Read moreProvider guide
A practical step-by-step guide for healthcare providers who want to join insurance panels.
Read moreProvider guide
Navigate behavioral health carve-outs and credentialing requirements for major payers.
Read moreProvider guide
Learn how payer contracts work and how to negotiate better reimbursement rates.
Read moreExpert contracting support
Our team specializes in Medica contracting for behavioral health facilities. We'll help you secure competitive rates and streamline your credentialing process.
Achieve significantly better reimbursement through expert negotiation
Reduce credentialing timeline from months to weeks
CAQH, state licensing, and accreditation guidance
Your personal contracting specialist throughout the process