No Surprises Act
Effective January 1, 2022, MedCost will ensure we are compliant with the requirements of the No Surprises Act. Due to these new regulations, we will need to provide regular updates and communication related to your participation in the MedCost Network(s). Email is the most efficient way to keep you informed, so please make sure you notify us of all demographic or provider status changes. You can make those changes quickly and easily on our website. In addition to communications from MedCost, the contact information you provide is used to ensure prompt and accurate claims processing and an accurate provider directory list for patients and other providers.
CAQH Reminders
If you are adding a physician to your practice or preparing for a provider to be recredentialed with MedCost, please follow the steps outlined below to make the process as seamless as possible and avoid delays in getting your provider added to the MedCost Network.
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If you are registered with CAQH, click here to supply MedCost with your CAQH ID . You also will 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.
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If you are not registered with CAQH, please visit 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.
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If you do not have internet access, please contact the CAQH Help Desk at 888-599-1771 and request a CAQH application be sent to you by mail. Simply complete the paper copy and fax it back to the toll-free number indicated on the application.
MedCost will notify you when the provider’s credentialing has been completed. You will receive a separate letter via email 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 submitted prior to the provider’s 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.
MedCost Works with Multiple Payer Partners
MedCost, LLC is in a unique position since we are both a leased provider network and a payer/administrator for employers with self-funded health plans through our TPA, MedCost Benefit Services. Since we work with multiple payers, please be sure to check the back of the patient’s ID card and submit claims to the appropriate payer/administrator to ensure you do not delay claims processing or payment.
It is always important to verify benefits for a patient to ensure you collect the appropriate co-payment, co-insurance, deductible, etc., at the time of service. This is especially true as we begin a new calendar year when benefits can likely change. Please obtain the most current copy of the patient’s insurance ID card at each visit and check members’ benefits. Payer information is listed on the back of the ID card; the payer will have the patient’s most current eligibility status. MedCost also offers a convenient listing on our website to give you a direct link to our payer partners with online access.
MedCost Provider Claim Activity Report (PCAR)
MedCost recently communicated news of our clearinghouse consolidation effective November 1, 2021. We also shared that after a brief transitional period, information regarding rejected claims will no longer be published to the Provider Claim Activity Report (PCAR). Instead, claims failing any of the edits previously communicated will be returned to the submitting provider for correction via 277CA transaction.
You can still access your PCAR for information on claims that MedCost receives and processes, including repriced amounts and which payer is handling adjudication of those claims. If you have any questions, please call our Customer Service Contact Center at 1-800-824-7406.