Provider E-Blast - North Carolina/South Carolina

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:

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:

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.

Multiple Surgery Claims (Modifier 51)

Multiple surgery claims should be billed with a modifier 51. Charges for secondary or subsequent surgical procedures where modifier 51 is appended will be repriced at 50% of the MedCost global allowable fee for that procedure unless your contract states otherwise. MedCost will consider the highest allowed procedure as primary unless your contract states otherwise.

The appending of modifier 51 on any CPT code designated exempt may result in denials by our payer partners.

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.