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26.11.2014
If you need to verify insurance benefits or obtain the status of a claim, please contact the claim administrator. MedCost is unable to verify patient eligibility since we are not the claims administrator and do not have information about members and dependents in our repricing system. The Affordable Care Act (ACA) requires all HIPAA-covered entities, which includes clearinghouses, health care providers, and health plans, to be compliant with any applicable HIPAA standards that are associated with operating rules.
There are three phases to the operating rules that were created by the Committee on Operating Rules for Information Exchange (CORE).
Phase III of the Operating Rules was implemented on January 1, 2014, and is specific to electronic funds transfers (EFT) and Electronic Remittance Advice (ERA) - 835. Certification requirements can vary, depending on the employer group’s benefit plan and the procedure to be performed.
A precertification request can be completed online by visiting the Provider portal on the MedCost web site. Certification Status – verify whether a medical procedure has been certified, non-certified, or is still in process.
If you are a participating MedCost provider, you should file claims to MedCost electronically using our EDI filing number, 56162.
Non-network providers should submit claims to the out-of-network claim mailing address listed on the member’s ID card. MedCost supports Claim Submission (837) for receipt and repricing of claims, which are then forwarded to the appropriate claim administrator for payment. Provider Claim Activity Report– This report contains information on repriced and non-repriced claims and can be run daily, weekly or monthly for all claims or by a specific member. MedCost Reference Guide – This resource gives providers information on all active, as well as inactive, companies that access or previously accessed the MedCost Network. If you have not registered yet to use our online tools, click here to sign up and gain access to these valuable resources. Notification about claims that cannot be repriced can be found on the Provider Claim Activity Report (under the Non-Repriced section shown at the top) or by using the MedCost Claim Repricing Inquiry tool to check a specific claim. MedCost does not maintain member level eligibility information, so we require group name and group number to ensure we process claims accurately.
MedCost publishes a Reference Guide that lists all employer groups accessing the MedCost Network and includes the group number, effective and termination dates, claim administrator name and web site, eligibility phone number, and pre-certification vendor and phone number. Yes, participating providers agree to accept the MedCost allowable for non-covered services. Please refer to the "Claims Filing" section of the MedCost Provider Manual for detailed information regarding our claim repricing guidelines.
For a complete list and a detailed explanation of modifiers that affect repricing, please refer to the "Claims Adjustment Policies" section of the MedCost Provider Manual. Payment for medical claims is issued by the claim administrator indicated on the patient’s identification card or the explanation of benefits.
Our web site provides direct links to many of our claims administrators who have online claim status. Before a provider can be added to the MedCost Network, he or she must be credentialed and approved. For more information about credentialing or re-credentialing, please refer to the MedCost Provider Manual on our web site.
MedCost strives to complete applications within 30 days; per the NC Department of Insurance, MedCost has up to 60 days. You should receive your user ID and temporary password within 30 minutes of registering.
We can issue only one administrative user ID since it is based on a practice’s tax ID. If you are unsure of the previous administrator’s login information or if the administrator is no longer with your practice, please click here to contact us or call our Customer Service Contact Center at 1-800-824-7406. If you have a large group with multiple practices under the same or different tax IDs and would like online access using only one administrative user ID, please contact us.


The manner in which your tax case is presented to the IRS is crucial in reaching a successful tax resolution. Unlike your communication with accountants and enrolled agents, your communication with an income tax attorney and his staff is confidential and privileged. Dealing with the IRS can be complicated, confusing, stressful, intimidating, and time consuming.
Todd Unger is a tax attorney who will simplify the process, minimize the stress, level the playing field, and take the pressure and time of dealing with the IRS off of your shoulders. Dealing with the IRS can be complicated, confusing, stressful, intimidating, and time consuming — but with a dedicated New Jersey tax attorney on your side, the process can be less daunting.
Whether you need assistance dealing with a tax lien, responding to an IRS notice, defending a tax preparer investigation, negotiating a tax settlement, filing for innocent spouse relief, handling an IRS appeal, challenging the IRS in Tax Court, reporting foreign bank accounts, or resolving back taxes owed, Todd Unger is a NJ tax attorney who will simplify the process, minimize the stress, level the playing field, and take the pressure and time of dealing with the IRS off your shoulders. When a claim is received, we verify that the employer group participates with MedCost using the employer’s group identification number and reprice the claim.
Do the Transaction Operating Rules that were implemented on January 1, 2014, and are specific to Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) impact MedCost? CORE is an initiative that was implemented by the Council for Affordable Quality Healthcare (CAQH). As of April 1, 2014, penalties may be assessed against a health plan that has failed to meet the certification and compliance requirements for standards and operating rules for electronic transactions.
With some claim administrators, enrollment for EFT happens automatically, but with others, you may need to contact the claim administrator directly to sign up for EFT. You should contact the claim administrator directly to verify if precertification is needed.
How does a provider complete a precertification request for a MedCost member who uses MedCost Health Management? A "Contact MedCost" feature allows you to provide patient policy information on non-repriced claims without refiling the claim to MedCost and also make requests to have non-received claims sent to the payer. It includes company name, group number, effective and termination dates, claim administrator name and web site, eligibility phone number, and precertification vendor and phone number. Where can a provider obtain a list of employer groups and their corresponding employer group numbers? MedCost works with many self-insured, or self-funded, employer groups where the employer pays health claims with its own funds.
MedCost requires that all providers meet our credentialing criteria during the initial and re-credentialing process, including the verification of active and approved licensure and accreditations. Providers will be notified that re-credentialing is due or, if you utilize CAQH, your information will be obtained directly from the Universal Provider Datasource (UPD). Providers can obtain information about the status of their credentialing applications at any point during the credentialing or re-credentialing process by calling our Customer Service Contact Center at1-800-824-7406. How does MedCost keep providers up-to-date on procedural changes, company news, and other pertinent topics?
This also allows MedCost to have a main contact person for any questions or issues concerning the web site.
If there has been no activity, a message will be sent to the e-mail address used to register the account.
To process this request, we will need the name of the practice(s), address(es), tax ID(s)and your contact information.
A New Jersey tax attorney like Todd Unger are trained negotiators who can present your case to the IRS in the most advantageous manner. The attorney-client privilege is essential if you have criminal tax exposure from unfiled tax returns, substantial understatements of income, foreign bank accounts, or have failed to remit payroll taxes. Enlist his help to make the stress of tax problems more manageable and to know how to respond in a way that lightens your burden instead of making it worse. Could you use help from the strong negotiating skills and in-depth knowledge of tax law that a NJ tax attorney like Todd Unger offers?
This contact information also can be found in the MedCost Reference Guide under the Provider portal of the MedCost web site.


Repriced claims are then forwarded to the appropriate claim administrator for adjudication.
The Operating Rules support electronic eligibility and claim status inquiries by streamlining and bringing uniformity to the administrative transactions between health care providers and health plans.
If you are uncertain about your EFT status with a MedCost claim administrator partner, please contact the claim administrator directly at the number located on the member’s ID card. If you do not already have a Health Management Applications login account, you can request one from the login page. With this tool, you can find contact information and links to web sites for over many of our claim administrators that provide online claim status. To ensure that your claim is processed under the correct group and delivered to the correct claim administrator for payment, MedCost uses both the group name and group number. To learn more about the Reference Guide and the Provider Web Applications, please click here.
New applicants will be notified within ten (10) business days of completion of credentialing and approval by the MedCost Credentialing Committee. It is extremely important that the re-credentialing information is returned as soon as possible to avoid possible termination from the network. For more information about credentialing or re-credentialing, please refer to the Provider Manual on our web site.
Please include your name, practice name, tax ID, and phone number in the body of the e-mail. While there are no guarantees in dealing with the IRS, Todd Unger will guarantee that he will fight tirelessly to obtain the best tax settlement or IRS resolution.
The attorney-client privilege provides a safe environment for you to disclose any information that may be relevant to your case without compromising your privacy. The IRS help Todd Unger provides can make all the difference in helping you achieve successful results. From trying to find tax relief to struggling with back taxes, dealing with the IRS isn’t something you want to do alone.
They are an addition to the existing standards that make electronic transactions more predictable and consistent. For additional assistance, please call our Customer Service Contact Center at 1-800-824-7406. If the group name is not provided on a claim that has a duplicate policy number, the claim will be returned to the provider for this information, creating unnecessary payment delays. If the claim administrator is MedCost Benefit Services, click here to login and check status. A provider is not considered a participant in the MedCost Network until the credentialing process is complete and a letter is sent to your practice indicating the provider’s effective date. For your Certificate of Liability Insurance, it is important to upload a copy of the actual policy in addition to completing the information in the CAQH application.
You also can verify participation by calling MedCost’s Customer Service Contact Center at 1-800-824-7406.
Todd Unger possesses the education, training, and experience to help you navigate through the complexities of the Tax Code and the IRS’s procedural maze.
For claims that have been submitted to MedCost for repricing, use the online provider tools, including the Claims Repricing Inquiry, Reference Guide, and Physician Claim Activity Report, to obtain the claim administrator’s contact information. As the tax lawyer New Jersey clients trust to resolve civil and criminal tax disputes, he has experience working with a wide range of complicated tax cases.



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