No Surprises Act - Provider Directory Update
The No Surprises Act (NSA) aims to protect patients from unexpected medical bills, bringing with it new requirements for provider directories. While full guidance from the government is forthcoming, MedCost has used a good faith approach to implement processes and procedures for maintaining accurate and up-to-date provider directory information.
90-Day Rule
Beginning January 1, 2022, MedCost is required to verify the accuracy of provider directory information at least every ninety (90) days. Each quarter, MedCost will contact providers by email to ask for confirmation that the information displayed in the provider directory is accurate and up to date. Providers must review their MedCost directory information, and if applicable, make any necessary changes by submitting the Provider Information Change form on the MedCost website. Providers can review their information by going to the online MedCost provider directory and selecting the applicable network.
Providers will continue to be required to submit data changes to MedCost as those changes occur:
- When terminating their contract with MedCost.
- When there are changes to any demographic information specific to content in the MedCost provider directory.
If you have changes at this time, you can submit those provider data changes to MedCost via the Provider Information Change form.
Updated Provider Manual
The revised version of the MedCost Provider Manual is now available. The sections related to Patient Identification and Corrected Claims have been updated.
As a reminder, the MedCost Provider Manual is the complete guide for MedCost Network providers and serves as an extension of your MedCost Agreement. Available as a downloadable file or viewable online, the manual guides you step-by-step through the administration of all MedCost programs. You will find detailed information on everything from contracting and credentialing, claims filing and processing, billing and collection to utilization management.
Behavioral Health and Telehealth Provider Demographic Information
We have revised the MedCost Provider Demographic form (included with contract materials for new providers) to alert providers that the main address entered on the form is published in the directory. If you previously listed your home address when joining the MedCost Network and do not want it published in the directory, please update your information by submitting an address change using the MedCost Provider Information Change form and noting the reason for the change in the “Miscellaneous changes/updates” section.
Behavioral Health Provider Claims
Effective 11/1/21, MedCost partnered with Availity as our exclusive EDI Gateway. Availity can work with your current clearinghouse to ensure claims are forwarded to Availity timely and from there to MedCost for processing.
Specific to behavioral health providers, your license number is not required when submitting claims, only your National Provider ID (NPI) and Tax ID should be filed. Since the NPI is mandated for use, claims filed using your license number could result in a rejection from the clearinghouse. NM109 is used in loop 2010AA.
If you have submitted claims with your license number and they have been rejected, please resubmit as outlined above.
If you are experiencing claim concerns or wish to submit claims directly to Availity, please contact Availity Client Services at 1-800-282-4548, option 2, Monday-Friday 8 a.m.-8 p.m.
Paper Claims - Billing Provider Address Reminder
As a reminder, effective March 1, 2022, all paper claims must be filed as follows. The billing provider address cannot contain a PO Box or Lock Box, and a physical address of the practice must be included in the following location of the claim form:
Claims Form Type Location
HCFA Box 33
UB Box 1
Failure to file in accordance with these requirements will result in the claim being rejected. An image of the claim with a cover letter will be mailed back to you, delaying your claim processing time.
Changes to Place of Service Codes for Telehealth
The Centers for Medicare & Medicaid Services (CMS) updated the current Place of Service code set by revising the description of existing POS code 02 and adding a new POS code 10 to provide greater specificity for telehealth services. MedCost will be prepared to receive claims with POS 10 and a date of service of 1/1/22 and after beginning April 1, 2022. As a reminder, this is driven by the date of service specified on the claim. Any claims with POS 10 submitted prior to April 1, 2022, will be processed once the system is updated to receive those claims.
Claims will be adjudicated based on the payer’s policies, as well as the member’s actual benefits for the service.
A breakdown of the new and revised POS codes is shown below:
Telehealth Place of Service Place of Service Definition
POS 10 Telehealth Provided in Patient’s Home
POS 02 Telehealth Provided Other than in Patient’s Home