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At MediGold, we take pride in our network of physicians and ancillary providers who provide our members with quality care and services.
This page is to be used as a resource for physicians and other providers who participate in the MediGold Provider Network or are interested in participation. From this page you can gain access to a variety of helpful links, documents and forms.
NEW! Provider Access and Availability Survey
Credentialing
To obtain recredentialing documents, please click here.
To become a network provider of MediGold, please click here.
NEW! Provider Portal
For access to MediGold's provider portal, with access to claims, remit and eligibility information, please complete the Portal Set Up form. A Provider Relations Specialist will complete your set up and return your login information.
If you have been assigned a password, access the Portal here.
Frequently Used Documents and Forms:
Claims guidelines and forms
Claims guidelines
Corrected Claims Form
Request for Claims Review Form & Instructions
Claims Status Inquiry Fax Request Form
Coding Guidelines
Pre-certification list and forms
Pre-Certification Request List & forms
Pre-Certification Request Form
MediGold Customized Certificate of Medical Necessity for Power Mobility Devices
Part D Formulary Exception Request Form
Part D Prior Authorization Forms
Miscellaneous
Provider Information Change Form
Post-cataract lens replacement form
Materials request form
Provider Remit Appeal Review Rights
Non-plan providers interested in disputing the payment amount should fax a "Claim Request for Review" form to MediGold's Audit department. Instructions for completing this form are located at this link.
The Claim Request for Review process does not apply to cases when a claim is denied; those cases should be forwarded under MediGold's standard appeal process.
Non-plan Provider Appeals Rights Form
Frequently used links
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