Reference 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.
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. Your HNS Service Representative's email address is displayed on the provider dashboard on the secure section of the HNS website.
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.
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.
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. Your HNS Service Representative's email address is displayed on the provider dashboard on the secure section of the HNS website.
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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