 MedCost QUICK REFERENCE GUIDE for chiropractic
MedCost Quick Reference Guide for Chiropractic
MedCost Preferred
Please do not send claims directly to MedCost!
Please Ignore the claims billing address on the member ID card or OR ANY INFORMATION GIVEN TO YOU BY PHONE WHEN VERIFYING BENEFITS REGARDING WHERE TO SEND CLAIMS! You are under contract through CNC and our instructions for filing claims supersede any information given to you by MedCost Representatives or the payor! ALL MedCost CLAIMS MUST BE SENT DIRECTLY TO CNC!
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 thier status as a Network Provider. (This includes any self-funded groups who utilize a CNC contracted payor as a third party administrator.)
Waiving Co-payments, Deductibles and Coinsurance
It is unlawful to waive co-payments, deductibles, coinsurances, or other patient responsibility
payments and is specifically prohibited by our contracted managed care partners.
This includes accepting a "lower" co-payment amount than the amount indicated on the member's subscriber ID card, waiving co-payments including for services deemed “professional courtesy” and TWIP (take what insurance pays).
Absent true financial hardship (with complete, current, supporting, documented evidence of such hardship maintained in the patient’s health record), the full amount of the co-pay as well as ALL co-payments, deductibles and coinsurance due and owed must be collected by all network providers.
For CNC Contracts:
Failure to consistently comply for individuals covered by a CNC contracted payor is in violation of the policies of our contracted payors and may result in the termination of your status as a CNC participating provider.
For Medicare:
Failure to comply for individuals covered by Medicare is a violation of the Federal False Claims Act,
Federal Anti-Kickback Statute, and the Federal and State Insurance Fraud Laws. Failure to comply may
result in civil money penalties in accordance with the new provision section 1128 A(a)(5) of the Health
Insurance Portability and Accountability Act of 1996 [section 231(h) (HIPAA).
General Information
MedCost began in Winston-Salem, NC in 1983 as a managed care organization and in the late 1980's began offering PPO services in the Carolinas. MedCost now offers comprehensive medical management services as well as offering one of the premier Preferred Provider Organizations in the Carolinas, including physician services, hospital services, ancillary services and hospice.
MedCost is used by many individual payor groups; therefore, benefit design varies by employer group. The member should present a MedCost card to identify members of this PPO. If you are unsure where to
send the claim when you receive the member’s insurance card, please fax a copy of the card along with the CNC Fax Inquiry Form to CNC. We will gladly fax you back your answer! If you have any questions about MedCost or a MedCost claim, please contact CNC before calling MedCost.
 Benefits/Eligibility
Telephone: Refer to the number listed on member’s insurance card to verify benefits. You may also refer to the MedCost Physician Reference Guide (a listing containing information specific to each employer group). For information on receiving this Reference Guide, click here.
PLEASE DO NOT call MedCost for benefit information. MedCost does not have benefit information on any members.
- Chiropractic benefits vary by employer group. Ask for specific information on Chiropractic benefits from each group/payor.
Referral System
- MedCost is a direct access plan and no referral from a PCP is needed.
- When necessary to refer to another health provider, referrals within the network are strongly recommended.
- No referral form is needed.
Co-payment/Co-insurance Collection
- No money is collected at the time of service unless there is a co-payment amount stated on the ID card or in the physician reference guide. We recommend that you always ask whether the member’s plan has a co-payment or deductible when verifying benefits.
- Some payors only require a co-payment, while others may have a deductible and co-insurance.
- Upon receipt of the notification of payment or remittance summary, provider may bill for any deductible or co-insurance up to MedCost’s allowed amount.
- Provider may not bill the member for the discounted amount.
- MedCost members are eligible for the PPO discount for each CPT code listed on the CNC/MedCost fee schedule. The patient is eligible for this discount even if the service is a non-covered service as determined by the payor (i.e., the payor does not cover a particular physical therapy code or if the payor does not cover chiropractic services). Be certain you have made the correct adjustments to the patient’s account if providing such services.
Claims Submission
Submit all claims to:
CNC
PO Box 2368
Cornelius, NC 28031
Ignore the address on the member ID card or any address given to you when verifying benefits and send all claims to CNC.
Please refer to the CNC Billing Instructions for complete information on claims submission.
- 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 (NOT CNC or MedCost).
- The claim must be identified as a MedCost claim in the address section at the top of the HCFA form (CNC/MedCost is an acceptable format). Be sure that you put the CNC address here.)
Example:
CNC/MedCost
PO Box 2368
Cornelius, NC 28031
- If filing MedCost as secondary, always attach copy of the primary EOB from the payor, and submit this, together with a new HCFA 1500 direct to CNC.
Claims Inquiries
- Resubmit corrected/lost/missing claims through CNC.
- If submitting a corrected claim, you must STAPLE the appropriate EOB to the HCFA 1500 and send to CNC. Please mark “corrected” claim on the HCFA 1500.
- For questions relating to payment of a claim, contact the payor shown on the notification of payment.
- Refer to your CNC/MedCost fee schedule to confirm allowable amounts.
Provider Relations
Questions relating to your participation in these MedCost products should be directed to CNC
at 704-895-8117, EXT. 2
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