|Form Name & Description||Form|
|Claim Reconsideration Form/|
Provider Appeals Form
We are transitioning to an electronic claim appeal submission. Starting April 1, 2023, this Word form will no longer be available. You will be required to submit your claim appeal electronically on our Provider Portal by selecting “Forms & Resources” then “Provider Appeal Form.” Call the Provider Contact Center at 1-888-633-4055 with any questions.
|Provider Adjustment Request Form||4357 (pdf)|
|Attachment Cover Sheet||4349 (doc)|
|Claims Error Codes & Descriptions|
Use the chart below to find information for South Country Health Alliance claims submission. For pharmacy claims, see
|Medical/Behavioral Health Services or Chiropractic||SCHA Provider Portal (website)
Payer Identification Number - 81600
|Dental Services||Delta Dental of Minnesota
P.O. Box 9120
Farmington Hills, MI 48333-9120
Payer Identification Number - 07000
Minnesota Uniform Companion Guides
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.