SAMPLE HCFA 1500

QUICK REFERENCE     GUIDE

PHYSICIAN REFERENE     GUIDE

INFO ON TRACING    CLAIMS

CLAIMS TRACING
    FORM

GREAT WEST     REMINDER

INCLUSIVE HEALTH

 

 

 

Medcost Physician Reference Guide


MedCost Physician Reference Guide
available monthly on the internet!

Medcost Physician Reference Guide


The Reference Guide is now available on MedCost secure web site. The Reference Guide is an excellent tool to obtain benefit information. This guide includes information about companies that access the MedCost network such as employer name, employer group number, the claim administrator and eligibility phone numbers. The guide also has the necessary information for properly completing boxes 11, 11B, and 11C on the HCFA form.  The Reference Guide is updated and available by the fifth business day each month.  There is no cost for this service.  If you are interested in registering, just print this page, complete the requested information and fax to CNC at (704) 895-8664.  CNC will register you right away!

Provider’s name: _________________________________________

Provider’s phone number:__________Fax #: ___________________

E-Mail address: __________________________________________

Name of person making this request: __________________________

Can’t Find a Company in the Physician Reference Guide
Or can’t determine where to send the claim?

PLEASE DO NOT CALL
MEDCOST

CNC Will Help!

If you’ve looked in the Physician Reference Guide and
still can’t identify a company/group,

FAX a copy of the ID card to CNC (704) 895-8664
together with your fax inquiry form
We’ll be happy to investigate and provide you with the proper information.


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