New Claim Correspondence Requirements for MedCost Benefit Services Effective April 1
As a reminder, the new claim correspondence requirements described below will go into effect April 1 for MedCost Benefit Services.
To expedite processing for solicited correspondence requested by MedCost Benefit Services (MBS) and facilitate identification of associated claims, the following information will be required to be included/attached to all solicited documentation effective April 1, 2025:
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Claim ID (located on EOB)
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Patient Name
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Patient Member ID Number
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Date of Service
You may begin including this information immediately to expedite claims processing.
Effective April 1, 2025, failure to submit the required information on solicited correspondence, resulting in our inability to identify the corresponding claim/s, may result in the correspondence being returned to your office to allow the required information to be resubmitted.
Provider Claim Inquiry Appeal Form Instructions
MedCost Benefit Services is responsible for resolving provider benefit claim denial appeals. Providers must use the Provider Claim Inquiry Appeal Form for provider benefit appeals to be accepted for MedCost Benefit Services products. All providers should use this form to submit provider benefit appeal requests on their own behalf.
To be valid for review, the form must be completed in its entirety, with all applicable fields filled (unless noted as if applicable or optional). Incomplete forms will be deemed invalid for review.
In addition to a completed form, you must include the following information with a cover letter:
Office Contact Name - The person listed as the office contact should be able to answer questions about the appeal and provide additional records.
Office Contact Information – Valid email address, phone number and/or fax number.
Supporting Documentation – Explanation of your request stating See attached.
Providers can use the Provider Claim Inquiry Appeal Form to submit a provider benefit claim appeal to MedCost Benefit Services on their own behalf for the following claim denials:
Medical Necessity (Post Service Claim Denials Only):
- Not Medically Necessary
- Cosmetic Services
- Investigational/Experimental Services
- No Authorization for Inpatient Hospital Admission
- Timely Filing Disputes
Providers must submit a claim appeal to Zelis Claims Cost Solutions on their own behalf for the following claim editing/coding denials:
Billing and Editing/Coding Disputes:
- Integral Part of Primary Service
- Mutually Exclusive
- Services Not Eligible for Separate Reimbursement
- Incidental Denial
- Surgical Global Period Denial
- Re-bundling
Zelia Claims Cost Solutions
2 Crossroads Drive
Bedminster, NJ 07921
[email protected]
Fax: 855-787-2677
Important notice - Claims editing/coding appeals must be submitted directly to Zelis and will not be accepted by MedCost Benefit Services. Claim editing/coding appeals misdirected to MedCost Benefit Services will not be reviewed, processed, or forwarded.