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South Country Health Alliance | Claims

Claims

Forms

Form nameFor 2018 and earlier dates of serviceFor 2019 dates of service
Claim Reconsideration Form/
Provider Appeal Form
3535 (doc)4356w (pdf)
Provider Adjustment Request FormN/A4357w (pdf)
Attachment Cover Sheet4349 (doc)4349 (doc)

Submission Information

Use the chart below to quickly find phone numbers and addresses for easy claims submission. For pharmacy claims, see Pharmacy.

 For 2018 and earlier dates of serviceFor 2019 dates of service
Medical/Behavioral Health Services
or Chiropractic
Mayo Clinic Health Solutions (website)
P.O. Box 211698
Eagan, MN 55121
1-800-995-4543
Payer Identification Number - 81600
SCHA Provider Portal (website)
1-888-633-4055
Payer Identification Number - 81600
Dental ServicesDelta Dental
Attn: Claims
P.O. Box 1328
Minneapolis, MN 55440
Payer Identification Number - 07000
Delta Dental
Attn: Claims
P.O. Box 1328
Minneapolis, MN 55440
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.