Search
Looking For a Doctor or Facility?
Provider Onboarding
Get the MedCost Provider Manual
Here you can access the complete guide for providers. Our comprehensive online resource will guide you step-by-step through the administration of all our programs. You will find detailed information on everything from contracting and credentialing, claims filing and processing, billing and collection to utilization management. Download the PDF—no login or password is required.
To view the manual as a PDF, Adobe Acrobat Reader must be installed on your computer. Download this free software from www.adobe.com.
Provider Manual Updates
Periodically, we may need to provide information updates. We treat our Provider Manual as an extension of your MedCost agreement. You will be notified of any updates or revisions to the manual through our provider e-news or e-mail blasts and through postings to the provider portal of our site. If you print a hard copy of the Provider Manual to have as a reference, make sure you maintain and update your copy as needed.
Please include your Practice Name, Tax ID, Contact Name and Phone Number in the body of the email.
Claims Filing Tips
To ensure efficient processing of your claims, please adhere to the following guidelines:
Verify Payer ID: Always double-check the member’s ID card to ensure you are using the correct payer information.
Electronic Claims Submission: For NC/SC electronic claims submission, use MedCost Payer ID 56162. MedCost exclusively accepts electronic claims through Availity, our designated EDI gateway. For assistance with electronic claims submissions or any Availity-related inquiries, contact Availity Client Services at 1-800-282-4548.
Required Information: Include the employer group name, group number, and member ID on all claim submissions to MedCost. Claims lacking this information will be denied.
Provider of Service: All claims should include the provider of service name. Group names are not acceptable.
Assignment of Benefits: Indicate assignment on the claim (patient signature or “Signature on File”); group names are not acceptable.
Provider Manual: For comprehensive claims filing guidelines, refer to the MedCost Provider Manual.
Claims Edits: All submitted claims will undergo editing checks as applicable. Any claims that fail these edits will be returned for correction via 277CA.
Other Important Reminders:
Eligibility and Benefits: To verify eligibility, deductible, or coverage information, contact the payer on the back of the member’s ID card.
Patient Billing: MedCost members may only be billed for their applicable deductible, coinsurance, or co-pay amounts at the time of service.
Provider Demographic Updates: Notify MedCost immediately of any changes to your practice, including any changes in address, practice name, or telephone number.
News and Updates: Stay informed about important process changes and announcements by reading all news blasts from MedCost.
Allowable Requests: Allowable requests can be made through the online MedCost secure provider portal or via email.
