Excellence In Medical Administration
MedCost Benefit Services offers employers cost-effective, accurate and timely administration of their medical claims. Our commitment to service excellence, coupled with external audits by independent, nationally recognized organizations that have validated our claims operations as best in class, means that our clients can trust that MedCost Benefit Services has the experience, expertise and capability to handle all of their claims administration needs. We have experience administering plan designs ranging from a basic Medical Assistance Plan to traditional medical plans and consumer-driven health plans
MedCost Benefit Services uses a sophisticated automated workflow distribution tool to streamline claims processing and to ensure the right claims analyst is performing the right task at the right time. We receive 98% of our claims via Electronic Data Interchange (EDI), which allows us to process claims quickly and accurately. Our claim processing system provides online edits for coordination of benefits (COB), preexisting conditions, subrogation, and "rebundling" of claims. We use the leading clinical editing software available to review coding accuracy and appropriateness before claims move to adjudication, resulting in a reduction of overpayments or unnecessary payments to providers and considerable savings for our clients. All financial aspects (funding, reinsurance and subrogation) are integrated with our claims administration, resulting in exceptional risk management.
The MedCost PPO Network offers substantial cost savings to employers and is the primary network used by MedCost Benefit Services. To meet the needs of our clients outside the Carolinas, MedCost Benefit Services also maintains positive relationships with national networks for primary network and travel, and has partnered with Virginia Health Network to be the exclusive third party administrator of VHN ULTRA.