Fulcrum’s claims vendor is waiving timely filing for 2024 dates of service related to the Change Health Data Breach. 



This allows providers time to reconcile 2024 claims issues due to the disruption. The waiver ends on 12/31/24.

Thank you for responding to the 2024 Provider Satisfaction Survey!  

The survey results are important for us to develop the annual Quality Initiatives.

Based on your responses from the 2023 survey, we are pleased to report in 2024 the following quality initiatives were implemented:

• Simplified the phone process and provided timely response.
• Enhanced the provider portal with UM Clinical Policies combined into a single document.
• Revised credentialing and recredentialing instructions to improve timelines.
• Simplified Outcome Assessment Tools (OATs) submission process for Gold tier providers.

Fulcrum Heath and Medica Health Plan Solutions (MHPS) payor relationship expires as of December 31, 2024, and Fulcrum will no longer be managing the chiropractic provider network for Medica.

Please submit all claims for 2024 dates of service in a timely manner to Fulcrum as claims received after June 30, 2025, will no longer be accepted. 

For dates of service January 1, 2025, and after, claims should not be submitted to Fulcrum Health, Inc.  MHPS employer groups will be migrating to OptumHealth Physical Health (OPH). Please refer to the Member ID card for claim submission instructions to OPH.   Please contact complementarynetwork@medica.com with questions you have regarding the transition.

We appreciate your participation in the Fulcrum Health network and if you have any questions, contact Fulcrum at providerservices@fulcrumhealthinc.org or (877) 886-4941.

To help ease administrative burden, QConnect correspondence delivery method will be changing to email delivery instead of fax notifications.

Please ensure your email address used to log in to Fulcrum's Provider Portal is active and checked for authorization related communications.

The change from fax notifications to email notifications will occur no later than 01/1/2025. You will still receive a copy of your authorization outcome letter through USPS mail.

The federal No Surprises Act (H.R. 133, P.L. 116-260) requires providers and health plans to verify the accuracy of provider contact information every 90 days.

Complete the following steps every 90 days to attest, which fulfills the No Surprises Act requirement: 

Step 1: 

View/Update Demographic Information on Fulcrum's Provider Portal.

• Click on the location that you would like to view/update.
• Enter your updated information along with the effective date and then click the Submit button for your changes to be saved.

Step 2:

Attest

• Click on the NSA Attestation button and check the checkbox after reading the attestation and click Submit button.



If you need to add a location, or are moving locations, please review the instructions on the Demographic Updates tab on the portal for how to complete.