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Claims Processing and Self-Service Opportunities

To check claim status for a plan administered by our third party administrator, MedCost Benefit Services, we encourage you to access the secure online provider portal where you can register to review claims, see EOBs, inquire about member eligibility, and review flex and SPD plan documents. (Instructions for registering can be found here.) Utilizing the online portal as your first resource will provide the most current claim status and help to decrease hold times through Customer Service. It is important to note that the status shown online is the same information accessed by our Customer Service team.    

To ensure claims are processed as timely and accurately as possible, there are ways you can help:   

  • 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. 

  • Submit the applicable group number and name on the claim. 

  • Submit complete and accurately coded claims. 

  • Follow industry standard coding guidelines, including applicable modifiers, as defined by the current Uniform Billing, ICD-10, and CPT manuals.

  • Follow the American Medical Association’s (AMA) guidelines that state the reported/billed code(s) “accurately identifies the service performed.”

  • Check the Provider Claim Activity Report (PCAR) and/or the 277CA Transaction Acknowledgement if you cannot validate online that a claim has been received or is in process by MedCost, to ensure it was not pended or rejected. 

  • If you have verified receipt using the above tools but are unable to locate the claim on our portal, please allow up to 30 days after submission for a claim’s status to be posted online. If status is not available after that time, please submit an online request or email [email protected]. Do not send a duplicate claim as it only increases overall claims inventory and slows processing of your original claim.   

  • Submit additional information for pended claims as timely as possible if requested so processing can continue without further delay. Please do not submit duplicate copies of requested documentation to speed up processing if claim shows as “in process.”