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Provider eBlast April 2019

ADDING A PROVIDER TO YOUR PRACTICE    

As you add providers to your practice, please ensure that you notify MedCost promptly. You can visit https://www.medcost.com/providers/my-account/add-provider-practice to submit the provider’s information. This information will allow us to add the provider to our network and avoid claim issues. A provider must be added to be considered in-network and for proper adjudication of any claims.
 
You will need to complete the above referenced form in its entirety and include your Council for Affordable Quality Healthcare (CAQH) ID. It is also important to include your practice name or doing business as (DBA) name on the form to be certain the provider is added to the appropriate practice.

Once the provider is added to the MedCost Network, you will be notified. Any claims processed prior to the provider’s effective date will be considered out-of-network. 


CLAIMS FILING REMINDERS

It is important to verify a member’s benefits and eligibility at each visit. For questions specific to benefits, coverage, or eligibility, please contact the claim administrator at the phone number shown on the patient’s ID card. This will help to ensure you collect the correct amount due to you at the time of a visit.

MedCost also recommends the following claims filing guidelines for quicker processing and payment turnaround: 

  • MedCost follows coding guidelines as defined by the current Uniform Billing, ICD-10, and CPT manuals when repricing claims.
     
  • We accept the American Medical Association’s (AMA) guidelines that state the code(s) reported/billed “accurately identifies the service performed.”
     
  • In addition, MedCost also requires compliance with the HIPAA standardized code sets and thus only considers valid and current ICD-10 (or its successor), CPT-4, and HCPCS codes with their appropriate modifiers.
     
  • We also agree with AMA’s statement in their introduction to the CPT-4 manual, that, “inclusion or exclusion of a procedure does not imply any health insurance coverage or entitlement to reimbursement.”
     
  • Services that are inappropriately billed, unbundled or subject to a reduction, should not be billed to the patient.
     
  • CMS guidelines may also be used as a guide for filing claims.

Please follow these guidelines to avoid problems with claims repricing and payment. Improper coding may result in incorrect repricing and/or payment delays. Services may also be denied by our payer partners based on the payment policies defined for correct coding. Our payer partners adjudicate claims based on an employer group’s plan design.