Avoid These Common Rejections When Filing Claims to MedCost
Paper Claims - Billing Provider Address
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:
|
Claim 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.
Group Number and Group Name
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
The presence of this data assists us with policy/provider validation and ensures your claims are repriced correctly and timely so they can be routed to the appropriate claims administrator for adjudication.
Filing Provider & Facility Claims Zip Codes
For all billing providers, zip codes (Loop - 2010AA N403) must be submitted with 9-digit zip codes in this field. In addition, claims containing facility information, facility address, or service facility location must have the required 9-digit zip code for the facility address. No spaces or separators should be included within the zip code information, or the claim will be rejected at the clearinghouse. Example 9-Digit Zip Code Entry: 123456789
The 837 fields required for zip codes include:
|
837 Reference |
837 Professional Data Element Reference |
837 Institutional Data Element Reference |
Professional Paper Claim Form CMS 1500 Data Element Reference |
Institutional Paper Claim Form UB04 Data Element Reference |
|
Service Facility or Laboratory Facility Postal Zip Code |
Loop 2310C N403 unless overridden when reported in Loop 2420C N403 |
Loop 2310E N403 |
Item Number 32 Service Facility Location Information Line 3 |
Form Locator 1 Line 3 |
Full nine-digit zip codes are required in the Billing Provider and Service Facility Location loops. If five-digit zip codes are used in these loops or any other unacceptable format, a 277CA will be returned to the submitter identifying the rejected claim(s). This will delay your claims from processing.
Thank you for your attention to this matter and for being a MedCost provider partner. If you have any questions, please contact MedCost Customer Service at 1-800-824-7406 or via Live Chat on MedCost.com.
REMINDER: If you need to make changes to your provider demographic information, please complete and submit the Information Change form.