Provider E-Blast - North Carolina / South Carolina

Credentialing Your Residents with MedCost 

It’s that time of year again, when providers are finishing their residencies. If you are adding a physician who is about to complete their residency to your practice, MedCost can begin the credentialing process three months prior to the completion of their residency. Please note that the provider will not be made effective until after their residency completion date. 

• If you are registered with CAQH, click here to supply MedCost with your CAQH ID. You also will need to log into the UPD database at https://proview.caqh.org/PO and add MedCost as one of the health plans authorized to access your information. This will allow MedCost to obtain your current credentialing information from the UPD database.

• If you are not registered with CAQH, please visit https://proview.caqh.org/PR/Registration to register and add MedCost as one of the health plans authorized to access your information. Once you receive notification from CAQH that your application is complete, click here to supply MedCost with your CAQH ID.  

• If you do not have Internet access, please contact the CAQH Help Desk at 888-599-1771 and request a CAQH application be sent to you by mail. Simply complete the paper copy and fax it back to the toll-free number indicated on the application.

MedCost will notify you when the provider’s credentialing has been completed. You will receive a separate letter in the mail indicating the provider’s effective date. Please do not submit any claims for the new provider until you have received notification of the provider’s effective date to ensure claims are correctly processed as in-network. Any claims submitted prior to the provider’s effective date will be considered out-of-network.

If you have any questions, please call our Customer Service Contact Center at
1-800-824-7406.

Adding A Provider To Your Practice

As you add providers to your practice, please ensure that you notify MedCost promptly. You can visit Add a Provider to a Participating Practice | MedCost to submit the provider’s information. This will allow us to add the provider to our network and avoid claim issues. A provider must be added to be considered in-network and for proper adjudication of any claims.
 
You will need to complete the above referenced form in its entirety and include your Council for Affordable Quality Healthcare (CAQH) ID. It is also important to include your practice name or doing business as (DBA) name on the form to be certain the provider is added to the appropriate practice.

Once the provider is added to the MedCost Network, you will be notified. Any claims processed prior to the provider’s effective date will be considered out of network.

Corrected Claim Reminders

When resubmitting an existing claim to MedCost as a corrected claim (with a specific change or addition to the original information and the appropriate corrected claim indicator), the guidelines shown below must be followed to ensure timely and accurate adjudication using the corrected information. Corrected claims that are not filed according to these guidelines will be denied.

All corrected claims should be filed through your normal claim submission channel. The successful submission of a corrected claim will result in the retraction and replacement of the original claim. For faster and more accurate processing, the preferred method for submitting claims to MedCost is via electronic data interchange (EDI).

Guidelines for Filing a Corrected Claim to MedCost

• For UB-04 claims, a “7” must be present as the third digit of the Type of Bill field. For paper claims, the original claim number should be entered in Field 64.

• Professional claims also should reflect a claim frequency code of “7.” For paper claims, the original claim number should be entered in Box 22.

• Edit the claim with the corrected information.

• Include the payer’s original claim number in the 2300 claim loop - segment REF01=F8 and REF02=the original claim number with no dashes or spaces.

  • Enter the original claim number of the paid/denied claim when submitting a replacement with frequency of “7” (Replacement of Prior Claim). CLM05-03 (837P).

  • In the 2300 Loop, the REF02 segment [Original Reference Number (ICN/DCN)] must include the original claim number issued to the claim being corrected. The original claim number can be found on your Remittance Advice.

  • Failure to include the original claim number and/or use a corrected claim indicator may impact the processing of your claim. Please note, a corrected claim does not constitute an appeal.

• Resubmit through normal channel.

• If filing a paper claim, the billing provider address cannot contain a PO Box or Lock Box, and a physical address of the practice must be included in the following location of the claim form:​​​​​​

• Failure to file a paper claim in accordance with these requirements will result in the claim being rejected.  An image of the  claim with a cover letter will be mailed back to you, delaying your claim processing time.