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Tools and resources to manage your practice administration

Here you will find the tools to help you manage your practice’s claims, reimbursement and patients. It’s helpful to know that to health care professionals, MedCost is an administrator of plans and the payer, but MedCost is also a provider network product. MedCost extends its provider network product to plan sponsors through established relationships with payer partners including administrators and carriers. Please consult the member ID card to determine the appropriate payer.

Precertification

  • Submit and manage your practices precertification requests electronically.
  • Only available for members listing MedCost for certification on the back of their ID card.

Eligibility and Benefits

Check patient eligibility and see patient co-pay, deductible and coinsurance amounts in one of two ways:

  1. Check patient eligibility for MedCost administered plans through our secure provider website.
    Only available for members with MedCost listed as payer on the back of their ID card.

  2. Contact the payer partners listed on the back of the member ID card. MedCost extends its provider network product to our payer partners who can provide eligibility information for their members.

Claims Payment and Reimbursement

The payer handles all claims payments. Manage your practice’s receipt of payments in one of two ways:

  1. For member ID cards listing MedCost as the payer, providers can check payment status through our secure provider website.

  2. MedCost extends its provider network product to our payer partners, and they provide payment status.  

Claims Submission and Repricing

  • Submit claims to the EDI number listed on the back of the member’s ID card.
  • To check the status of your repriced claims, access the claims repricing resources using our web application services.  

Reference Guide

A health care provider resource that includes a complete listing of employers accessing the MedCost provider network, their group number, effective and termination dates, as well as their payer and precertification vendor. Eligibility and benefits information is not available within the Reference Guide.

Payer Partners

MedCost has established relationships with more than 70 payer partners that lease our provider network. Most of these payer partners offer online claim status or eligibility. To identify the payer, you will need to consult the member ID card. View payer partners or the Reference Guide which includes a full list of payers leasing MedCost’s network.