MedCost QUICK REFERENCE GUIDE for chiropractic
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 CNC/Payor Policies, CNC Documentation, and CNC Billing Guidelines.
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 CNC and our instructions for filing claims supersede information given to you by MedCost Representatives or a MedCost payor!
All claims for COVERED SERVICES provided to a beneficiary of a CNC contracted payor MUST be submitted to CNC. Participating providers who fail to submit all such claims to CNC may lose their status as a Network Provider.
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 about a MedCost claim, please contact your CNC Provider Rep before calling MedCost.
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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. CLICK HERE to see a sample Verification of 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 CNC for eligibility and benefit information. Neither MedCost nor CNC 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.
Referral System
- MedCost is a direct access plan and no referral from a PCP is needed.
- When necessary to refer to another healthcare 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 CNC; therefore, neither MedCost nor CNC 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. The two main MedCost logos to look for on an ID card are:
 
Please note the importance of correctly identifying a MedCost member ID card. If you do not submit your MedCost claims to CNC, 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, use your CNC Fax Inquiry Form to ask your CNC Provider Rep for assistance.
The sample ID card below shows that this member is a MedCost Preferred member. The actual payor for this member is Guardian. Some MedCost ID cards will have hand written member names and explain that the member's social security number (SSN) is the member ID number.
Please note: These copies are not from original member ID cards and we apologize for their lack of clarity, but wanted to show the MedCost ID cards in their many appearances and logos.
Please note: MedCost family members may be included all on one ID card or may be issued separate ID cards. It is important to always put the correct member ID number in your practice management software and on your insurance claim.
If you are uncertain about where to file the claim, please use your CNC Fax Inquiry Form and fax a clear, legible copy of the member ID card to CNC 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 CNC 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 CNC through the ChiroTrack® system. Exceptions include secondary claims, corrected claims, any claim with an attachment and Inclusive Health claims*.
CLICK HERE for information on filing secondary claims.
CLICK HERE for information on filing corrected claims.
* Inclusive Health is not a MedCost payor, please CLICK HERE for information on filing Inclusive Health claims.
Ignore any instructions regarding where to submit claims by payor phone representatives. CNC 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 CNC Billing Guidelines.
- Group or policy number must be in box 11.
- Employer name must be in box 11b.
- Payor (i.e., Unicare, Mutual Group, etc.) must be in box 11c as well as MedCost (example: Unicare/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 (CNC/MedCost is an acceptable format) using the example address below:
Example: CNC/MedCost
PO Box 2368
Cornelius, NC 28031
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Claims Inquiries
- For tracing overdue claims (after 60 days from your billing date), complete the CNC Fax Inquiry Form and fax to CNC. Please 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 3 business days.
- Resubmit lost/missing claims through CNC.
- Refer to your CNC/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 CNC Provider Rep
at
(877) 426-2411.
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