The MedCost credentialing program has been accredited by URAC since 2000. Before a physician or facility is added to the MedCost network, the physician or facility must be credentialed and approved. In order for physicians and facilities to remain in the network, they must also follow an approval process for re-credentialing.

NOTE: Non-participating providers in North and South Carolina that wish to join our network should contact the MedCost Customer Service Contact Center at 800-824-7406 for additional information, or go to How to Join Our PPO Network.

Downloading Credentialing Applications
Credentialing cannot be completed until we have received a completed credentialing application with attachments as applicable. Please review below to access the correct credentialing application for your location and purpose. At this time, applications cannot be completed online. Please download and print out the application you need and mail or fax it to MedCost.

1. Physician Recredentialing Application.
MedCost is required to recredential participating professional providers every three years. MedCost will advise you of this at least four (4) months before your current credentials expire. We make every effort to direct this information to the correct address and person responsible for network credentialing issues. We ask that you ensure that these types of requests are forwarded to the appropriate staff member within your organization as it is extremely important that we receive the information necessary to expedite the re-credentialing process. If this information is not received prior to the date that your existing credentials expire, you may be terminated from the MedCost network.

All providers due for recredentialing should complete our "MedCost Recredentialing" form. (Please note, if you have never been credentialed by MedCost please complete the application in Section 2 below).

MedCost Recredentialing Form (Print Version - PDF Format)

MedCost Recredentialing Form (Fillable Version - PDF Format)

2. Physician Initial Application.

North Carolina professional providers in NC are required to complete the most current version of the North Carolina Department of Insurance’s Uniform Application to Participate as a Health Care Practitioner developed for credentialing.

If you are a NC provider joining our network, you may print the following application in PDF format:

Uniform Credentialing Application - North Carolina (Print Version - PDF Format)

Uniform Credentialing Application - North Carolina (Fillable Version - WORD Format)

South Carolina professional providers in SC may complete the South Carolina Managed Care Provider Credentialing Application or use the above Uniform Credentialing Application for North Carolina.

Uniform Credentialing Application - South Carolina (Print and Fillable Version - PDF Format)

If you are a provider outside of North and South Carolina, please complete the Uniform Credentialing Application for North Carolina.

3. Facility Application.
MedCost is required to re-credential participating facilities every 3 years. If you are a facility due for recredentialing, complete our "Hospital and Facility" form:

Hospital and Facility Recredentialing Form (Print Version - PDF Format)

Hospital and Facility Recredentialing Form (Fillable Version - PDF Format)

Credentialing Instructions
The following instructions will assist in ensuring your application is not delayed for missing information with an incomplete application:

Provider Applications:
• Completed application with current date and signature
• Copy of provider's state license
• Copy of the face sheet of your current professional liability insurance policy, indicating name of the practice, name of the provider covered, coverage amounts, effective date, expiration date and policy number
• Copy of certificate from Specialty Board
• Copy of Curriculum Vitae or work history
• Explanation to all "Yes" responses on "Professional Information" questionnaire

Facility Applications:
• Completed application with current date and signature
• Copy of applicable accreditation (JCAHO, URAC, ACR, AAACH, NACC, ACHC, American Lithotripsy Society, CHAP, CARF, AAASH, American Board of Orthotics & Prosthetics, ISO900, Dialysis Facilities, AASM, ICAVL, Board for Orthotist/Prothetist Certification (BOC), HQAA
• Copy of state license
• Copy of Medicare certification
• Copy of Medicaid certification
• Copy of current liability insurance
• Copy of secondary or excess liability information

Submitting Applications
Submit your completed application and applicable attachments to:

Email: credentialingapps@medcost.com
Fax: Attn: Credentialing Department - 336-970-2139
Mail: MedCost, LLC
Attn: Credentialing Department
P.O. Box 25347
Winston-Salem, NC 27114-5347