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.
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
MedCost Virginia Provider Account Login Change Coming in March
As part of our ongoing commitment to grow stronger together and better together, the way you log in to your MedCost Virginia provider account is changing. This change will simplify the way you access payor list matrix documents and EDI claims submission reports. Look for more details and information in the coming weeks.