Payer Forms | MedCost

Looking For a Doctor or Facility?

HPI Acquires MedCost

We are excited to share that MedCost has been acquired by Health Plans, Inc. (HPI), a national leader in self-funded health plan solutions. Read the full press release.

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?

HPI Acquires MedCost

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?

HPI Acquires MedCost

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