Claim administrators working with MedCost can now opt to receive utilization review certification notifications electronically. Electronic certification notification-“E-certs”-provides the same information claim administrators have always received from MedCost, but delivers it in a more efficient way.

How E-certs Work
Claim administrators that participate in E-certs are identified by an E-cert ID in the claim administrator record. Each business day health management staff create and review the prior workday’s certification log. Electronic certification records are created for all E-cert-identified claim administrators with activity on the log. The E-cert file is encrypted and posted on MedCost FTP (file transfer protocol) site by 2 p.m. daily. The file is placed in a certification folder specifically dedicated to the claim administrator. The claim administrator, using access and login privileges as assigned by the MedCost IS department, checks the FTP site between 2 and 5 p.m. to retrieve their E-cert file. The FTP site will retain up to five days’ information, should the claim administrator elect not to check the site on a daily basis.

The E-certs delivery option offers two significant advantages compared to standard methods of notification:

• Speed. E-certs are available much faster than logs or letters sent via U.S. mail. Notifications sent though the mail may be received two, three, or more days after the certification is completed. By contrast, E-certs are available to claim administrators after 2:00 p.m. on the next business day. With Department of Labor legislation emphasizing timely payment, receiving certification information electronically is preferable because it allows claim administrators to adjudicate claims faster.

• Efficiency. While claim administrators can choose to update their systems by manually entering E-certs data, maximum efficiency is gained when the electronically received files are “mapped” to their system. With mapping, E-certs data elements automatically drop into the claim administrator’s system, eliminating the need for manual data entry. This saves time, further enhancing the ability to adjudicate claims faster.

Need More Information?
Claim administrators seeking more information about E-certs should contact Renee Pulliam at MedCost. Renee can be reached by e-mail (rpulliam@medcost.com) or by phone (336-774-4201).