Claim Denial Notification Due to PO Box Address
As a reminder, the billing provider and service facility addresses must be a physical street address for both electronic and paper claims.
If filing electronically:
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It is no longer acceptable to use a PO Box, Lockbox, or any other address other than a physical street address.
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The billing provider address must be a physical street address.
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A PO Box or Lockbox should only be sent in the “Pay-To Provider” address field in loop 2010AB.
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A PO Box cannot be in loop 2010AA.
If filing paper claims:
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The billing provider address cannot contain a PO Box or Lockbox.
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The physical address of the practice must be submitted in Box 33 of the HCFA1500 form.
Filing Claims Electronically to MedCost
Filing claims electronically to MedCost is recommended and preferred. All EDI claims, regardless of type (institutional or professional), submitted for MedCost Payer IDs 56162 and 56205 will be received by MedCost through Availity.
If you wish to submit claims directly to Availity or would like to obtain more information, please contact Availity Client Services at 1-800-282-4548.
The following edits are monitored on all submitted claims to MedCost through Availity:
Standard National Implementation Process (SNIP) Edits 1, 2, 3 and 5:
SNIP 1 – Message syntax and valid data types
SNIP 2 – Additional format edits and valid values
SNIP 3 – Balancing service levels to claim level
SNIP 5 – Code set verification, i.e., ICD, CPT, etc.
- Provider NPI format must be valid wherever it is submitted on a claim, depending on claim form type.
- For MedCost Benefit Services members, the NM 109 element will be checked for valid subscriber/member ID. If this is blank or not valid, the claim will not be able to be processed.
- For members of leased payer groups, Loop 2000B Segment SBR03 Data element 127 will be checked for a valid group identifier. If this is blank or not valid, the claim will not be able to be processed.
Claims failing any of the above edits will be returned to the submitting provider for correction and will delay the claim from processing.
Filing Corrected Claims and Appeals
Corrected Claims:
All corrected claims should be sent to MedCost for applicable repricing. The original claim # is required to be submitted on the corrected claim. Please send corrected claims to the following address if paper; however, preference is to resubmit electronically to EDI 56162.
MedCost
PO Box 25307
Winston-Salem, NC 27114-5307
Claim Appeals/Disputes:
For Leased Payers, the EOB will provide information on where to submit disputes and/or appeals.
MedCost Benefit Services follows CMS guidelines on reimbursement related to NCCI (National Correct Coding Initiative) editing, including but not limited to procedure-to-procedure edits and medical unlikely edits. All appeals, claim disputes, or claim denials related to code editing should be sent to the following:
Zelis
Attn: Inquiries Department
2 Crossroads Drive
Bedminster, NJ 07921
[email protected]
Fax# 855-787-2677
If a corrected claim is included as part of the appeal, it must be sent to MedCost for repricing if there are any changes in reimbursement. Appeals and disputes should still be sent to the applicable payer partner listed on the EOB or member’s ID card.
Appeals related to benefit denials, such as plan exclusions, timely filing limit, patient responsibility disputes (co-pay, deductible, coinsurance), should be sent to the applicable payer on the member’s ID card. Benefit appeals could be for denials related to services not covered by the plan or reconsideration of a non-covered service.
For MedCost Benefit Services benefit appeals, you can send to:
MedCost Benefit Services
Attention: Benefit Appeals
PO Box 25987
Winston-Salem, NC 27114
Fax# 336-774-4420