tracelogoRBReference Guide for MedCost

 

The MedCost Quick Reference Guide provides information specific to MedCost concerning MedCost claims and MedCost policies. The information in this section is in addition to the HNS/Payor Policies.

 

NOTE:  MedCost and MedCost Benefit Services represent many different employer groups. Accordingly, benefits vary for each plan. As such, it is very important to verify benefits prior to providing treatment to MedCost members. When verifying benefits, please always clarify that treatment will be provided by a chiropractor. 

 

The MedCost Quick Reference Guide contains the following information specific to MedCost and provides you with helpful information regarding your MedCost claims.

 

General Information

 

Eligibility/Benefits

 

Referral System

 

MedCost ID Cards

 

Claims Submission

 

Claims Inquiries

 

Provider Relations

 


 


General Information

 

PLEASE REMEMBER: Do not send claims directly to MedCost!

 

Please ignore the claims billing address on the member ID card or any address given to you on the telephone when verifying eligibility and benefits. You are under contract as a participating MedCost provider through HNS and our instructions for filing claims supersede information given to you by MedCost Representatives or a MedCost payor!

 

With only a few exceptions, all claims for COVERED SERVICES provided to a beneficiary of a HNS contracted payor MUST be submitted to HNS.

 

MedCost is a PPO used by many individual payor groups; therefore, benefits will vary by employer group. The member should present a MedCost card to identify members of this PPO. If you have any questions regarding a MedCost claim, please contact your HNS Service Representative before calling MedCost. 

 

 

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Eligibility/Benefits 

 

Chiropractic benefits vary by employer group and by payor; therefore, please contact the payor directly for eligibility and benefit information. Please remember to ask for specific information on chiropractic benefits for each member when verifying benefits. CLICK HERE for the HNS Verification of Eligibility/Benefits Form.

 

  • Refer to the telephone number listed on the member's insurance card to verify eligibility and benefits.
  • You may also obtain the telephone number for the payor by referring to the MedCost Physician Reference Guide (a list containing information specific to each employer group).  For information on receiving this reference guide, CLICK HERE.
  • PLEASE DO NOT call MedCost or HNS for eligibility and benefit information. Neither MedCost nor HNS has eligibility and/or benefit information on any members. Please only call the payor listed on the back of the member's insurance card to verify eligibility and benefits.

 

 

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Referral System
 

 

MedCost is a direct access plan and no referral from a PCP is needed.  When necessary to refer to another health care provider, referrals within the network are strongly recommended.  No referral form is needed.

 

 

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Medcost ID Cards

 

MedCost ID cards are not issued by MedCost or HNS; therefore, neither MedCost nor HNS has control of how a MedCost ID card will appear. MedCost contracts with hundreds of individual payors and those payors issue individual member ID cards. There are hundreds of different variations for MedCost member ID cards. Most importantly, always remember to look for the MedCost logo to identify it as a MedCost card.

 

MedCost is no longer being referred to as MedCost Preferred. Although MedCost has updated their logo to remove the word "Preferred," there may be some member ID cards with the old logo. 

 

Please note the importance of correctly identifying a MedCost member ID card. If you do not submit your MedCost claims to HNS, you will not be properly paid for your services.

 

If you see any MedCost logo, please use the MedCost Physician Reference Guide to verify the employer group is active in the MedCost Network. If you are  unable to locate the employer group on the MedCost Physician Reference Guide, please email your HNS Service Representative for assistance.

 

If you are uncertain about where to file the claim, please email your HNS Service Rep for assistance and include a legible copy of the member ID card to HNS and we will respond back to you with an answer within 24 hours. 

 

A word on "Hospital Only" participation: 

If a patient presents a card to your office with the MedCost logo and the card says "Hospital Only," this patient does not use MedCost for provider claims (only for hospital admissions). Send claims for these members direct to the claims payor (i.e., Mutual Group, Guardian, Unicare, etc.) DO NOT send "Hospital Only" claims to HNS or MedCost. (Helpful hint: if you can't find a company in the MedCost Physician Reference Guide, double check the card to see if it says "hospital only." Companies using MedCost only for hospital admissions do not appear in the reference guide.)

 

 

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Claims Submission
 

 

All claims for MedCost contracted plans must be submitted to HNS through the HNSConnect® system.  Exceptions include secondary claims, corrected claims, and any claim with an attachment.

 

Update:  Effective January 1, 2015, a high deductible health plan (HDHP) option will be available to qualifying members of the NC State Employees Health Plan. MedCost Benefit Services will administer the new plan. As participating providers for MedCost, network providers must submit these claims to HNS. The cards will include the MedCost name and logo as well as "North Carolina State Health Plan".

 

All other State Employee Health Plan claims will continue to be administered by BCBSNC. 

 

Update: Effective January 1, 2015, claims for services provided to Mission Health members must be filed through HNS. Please be sure to obtain new subscriber ID cards and update your billing software to ensure these claims are filed to HNS, as claims submitted directly to Mission Health will be denied. 

 

CLICK HERE for information on filing secondary claims.

 

CLICK HERE for information on filing corrected claims.

 

Ignore any instructions regarding where to submit claims by payor phone representatives. HNS instructions regarding where to submit claims supersede all other instructions given by payor representatives when verifying benefits.

 

In order for MedCost claims to adjudicate quickly and accurately, please note the following information regarding claims submission specific to MedCost is in addition to the HNS Billing Guidelines.

 

  • Group or policy number must be in box 11.
  • Payor (i.e., Principal, Mutual Group, etc.) must be in box 11c as well as MedCost (example: Principal/MedCost)
  • Even when filing claims electronically, the claim must be identified as a MedCost claim in the address section at the top of the CMS 1500 claim form (HNS/MedCost is an acceptable format) using the example address below:

 
Example:  HNS/MedCost
                  PO Box 2368
                  Cornelius, NC  28031 

 

 

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Claims Inquiries
 

 

For tracing overdue claims (after 60 days from your billing date), please email your HNS Service Rep for assistance and include the patient name, date of birth, member ID number, and the dates of services in question. We will gladly trace the claim for you and will respond back to you within three business days.

 

Resubmit lost/missing claims through HNS.

 

Refer to your HNS/MedCost Fee Schedule to confirm allowable amounts.

 

 

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Provider Relations 

 

Questions relating to your participation in MedCost should be directed to your HNS Service Representative at (877) 426-2411.

 

 

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