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South Country Health Alliance | Claims

Claims

Forms

Form nameLink
Claim Reconsideration Form/
Provider Appeal Form
4356 (doc)
Provider Adjustment Request Form4357 (pdf)
Attachment Cover Sheet4349 (doc)
Claims Error Codes & Descriptions
Troubleshooting help
5126 (pdf)

Submission Information

Use the chart below to find information for South Country Health Alliance claims submission. For pharmacy claims, see Pharmacy.

ServiceContact
Medical/Behavioral Health Services
or Chiropractic
South Country Provider Contact Center
1-888-633-4055
Provider Manual Chapter 4, Provider Billing
Payer Identification Number - 81600
Dental ServicesDelta Dental of Minnesota
P.O. Box 9120
Farmington Hills, MI 48333-9120
1-800-774-9049
Payer Identification Number - 07000

Minnesota Uniform Companion Guides

Minnesota Uniform Companion Guides (web) The Administrative Uniformity Committee (AUC) provides common billing practices for Minnesota payers and providers. The companion guides help determine the most appropriate practices for your agency/facility.