Payer Forms | MedCost

Looking For a Doctor or Facility?

Certain web-based member assessment tools are temporarily unavailable. To enroll in the Personal Care Management or SmartStarts Maternity program during this time, please call 1-800-722-2157 and select option 2.

Here are the forms you need to assist you in completing administrative tasks quickly and efficiently.

If you have questions, please call our Customer Service Contact Center at 1-800-824-7406.

Add/Revise Client Form

New Client Form Master (Word)
New Client Form (PDF)
New Client Form (Word)

Employer Group Termination Form

Group Termination Form (PDF)
Group Termination Form (Word)

EOB Requirements Checklist Form

EOB Checklist (PDF)
EOB Checklist (Word)

ID Requirements Checklist Form

ID Requirements Checklist (PDF)
ID Requirements Checklist (Word)

Looking For a Doctor or Facility?

Why MedCost

Benefit Plans

Resources

Employer Account

Benefits

Claims

Care

Member Account

Coverage & Claims

For MedCost Administered Plans

For All Plans

Education & Training

Provider Account

MedCost Virginia

Forms & Documents

Add/Revise Client Form

Employer Group Termination Form

EOB Requirements Checklist Form

ID Requirements Checklist Form

Claims Repricing

Search

Looking For a Doctor or Facility?

For MedCost Administered Plans

For All Plans

MedCost Virginia

Frequently Used Payer Forms

Add/Revise Client Form

Employer Group Termination Form

EOB Requirements Checklist Form

ID Requirements Checklist Form

More About MedCost

Claims Repricing