Important Update For Claims Filed With Invalid Policy Information

As we close out an unprecedented year and look forward to 2021, MedCost has evaluated ways in which we can be more efficient in repricing and/or adjudicating your claims. After extensive examination of our current claims processes, we have identified several changes to increase efficiency and will be implementing these changes throughout the course of 2021. 

This communication serves as a courtesy outreach to ensure you and your staff have ample notice of the first change we are implementing, related to accurate group/policy numbers on submitted claims. In the past, MedCost accepted claims with invalid policy information, but this required manual intervention for processing. To minimize the possibility of error, improve our overall efficiency, and achieve the most effective claims processing, we can no longer support claims that are filed with inadequate or invalid policy information. Claims must be submitted with the appropriate employer group policy information, or they will be indicated as non-repriced on the MedCost Provider Claim Activity Report (PCAR). Until the correct employer group policy information is provided for the claim, it will not be processed. 

This change will be effective for any claim type—whether HCFA or UB, paper or electronic (837)—submitted to MedCost with a received date of 1/18/21 or later. The required item(s) needed on HCFA and UB claim forms to avoid a non-repriced claim include:

• Group number: Loop 2000B Segment SBR03 Data element 127

As stated in our MedCost Provider Manual, the presence of this data assists us with policy/provider validation and ensuring your claims are paid timely and accurately. Please feel free to forward this email to the business unit or appropriate staff members responsible for regularly checking your Provider Claim Activity Report to identify non-repriced claims. Click here for instructions on accessing the PCAR. 

Remember, the claims on the PCAR report are not able to be processed without your intervention and will remain non-repriced until you take additional necessary action. If you cannot locate the necessary policy information from a member’s ID card to correct a non-repriced claim or have further questions, please contact MedCost Customer Service at 1-800-824-7406 or via the web or Webchat.