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Importance of Member ID and Group Number for Claim Submission and Modifiers that Affect MedCost Pricing

IMPORTANCE OF MEMBER ID AND GROUP NUMBER FOR EFFECTIVE CLAIM SUBMISSION 

The ID card contains specific information for claims submission, including where claims should be sent and the member’s ID and group number. Reviewing this information at each visit will ensure that claims get to the right location and will help expedite processing. Request a current copy of a member’s ID card at each visit to find out if anything has changed with their coverage.    
 
Verifying benefits at each visit allows you to collect any co-payment, co-insurance, deductible, etc., at the time of service. If you have any questions about claim submission or benefits, please contact the payer that administers the member’s plan benefits at the Customer Service number indicated on the ID Card. 


MODIFIERS THAT AFFECT MEDCOST REPRICING 

MedCost has a few modifiers that may affect repricing of your claims. A list of those modifiers can be found on page 22 of the Provider Manual.  Some modifiers may allow repricing for an individual detail line that would not normally be allowed, based on the MedCost adjustment policies. Other modifiers may reduce the allowable amount based on factors such as multiple procedures. The MedCost allowable may be affected when modifiers are added to the CPT codes.  Please file modifiers that affect repricing in the first position on the claim. 

There are many modifiers listed in the Current Procedural Terminology (CPT) and American Society of Anesthesiologists (ASA) manuals, and some may affect the actual payment received from claim administrators.

Please follow the most current coding guidelines to ensure efficient processing of your claims to MedCost.