Credentialing Requirements For Network Participation
Providers must be credentialed and approved before they can be added to the MedCost network. They also must follow an approval process for recredentialing every three years to remain in the network. The MedCost credentialing program has been accredited by URAC since 2000, which ensures clients and members of our compliance with federal and state credentialing standards.
Streamlined (Re)Credentialing Through CAQH
To eliminate the need for practitioners to submit multiple credentialing applications, MedCost participates in the Council for Affordable Quality Healthcare (CAQH). Their Universal Provider Datasource® (UPD) enables a practitioner to submit a single standard application that is designed to meet the needs of all organizations involved in the (re)credentialing process. There is no cost to practitioners. You easily can update your information at any time, and you will be asked to verify the accuracy of the information quarterly.
MedCost has collaborated with Aperture Credentialing, LLC located in Louisville, Kentucky, to provide credentialing verification services for providers included in our network.
Aperture Credentialing, LLC, on behalf of MedCost, is able to access CAQH for professional providers’ credentialing information through the Universal Provider Datasource® (UPD). In an effort to make the process more uniform and to ease your administrative burden, CAQH will help with the collection of your credentialing information.
If you are registered with CAQH, click here to supply MedCost with your CAQH ID . You will also need to log into the UPD database at https://proview.caqh.org/PO and add MedCost as one of the health plans authorized to access your information. This will allow MedCost to obtain your current credentialing information from the UPD database.
- If you are not registered with CAQH, please click here https://proview.caqh.org/PR/Registration to register and add MedCost as one of the health plans authorized to access your information. Once you receive notification from CAQH that your application is complete, click here to supply MedCost with your CAQH ID.
If you do not have internet access, please contact the CAQH Help Desk at 888-599-1771 and request a CAQH application be sent by mail. Simply complete the paper copy and fax it back to the toll free number indicated on the application.
For facility credentialing, an Organizational Credentialing application will be sent via fax, email, or mail to the credentialing contact for the facility. The application should be completed and returned as indicated on the request, including all required documentation.
MedCost will notify you when the provider’s credentialing has been completed. You will receive a separate letter in the mail indicating the provider’s effective date. Please do not submit any claims for the new provider until you have received notification of the provider’s effective date to ensure claims are correctly processed as in-network. Any claims prior to the effective date will be considered out-of-network.
If you have any questions, please call our Customer Service Contact Center at 1-800-824-7406.