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South Country Health Alliance | Claims

Claims

Forms

Form name 
Claim Reconsideration Form/
Provider Appeal Form
4356w (pdf)
Provider Adjustment Request Form4357w (pdf)
Attachment Cover Sheet4349 (doc)
Claims Error Codes & Descriptions
Troubleshooting help
4780 (pdf)

Submission Information

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

  
Medical/Behavioral Health Services
or Chiropractic
SCHA Provider Portal (website)
1-888-633-4055
Payer Identification Number - 81600
Dental ServicesDelta Dental of Minnesota
P.O. Box 9120
Farmington Hills, MI 48333-9120
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.