INSURER FILING GUIDE

MedCost (North Carolina TPA)

Use this public information to prepare your packet, then confirm the route on the insurer's own page.

AT A GLANCE

Claim facts

Member form	Statement of Medical Claim Number: MBS-010 Revision: Rev05152014 Open the insurer form
Portal upload	YES
Portal path	Log in to the Member account > eForms; the exact post-login claim form and controls are UNREADABLE
Mail address	MedCost Benefit Services d/b/a MBS Third Party Administrators in California, P.O. Box 25987, Winston-Salem, NC 27114-5987
Fax	(336) 774-4420
Attachments	Not published by the insurer: the form permits an itemized bill instead of the provider page but does not enumerate required itemized-bill fields
Deadline	Not published by the insurer
Outcome and status	MedCost Member account > Claims history and EOBs; My MedCost app > Recent Claims
Processing time	Not published by the insurer
Caveats	Use this route only when MedCost Benefit Services is the claims payer; a MedCost network logo alone does not establish the administrator; employer self-funded terms and out-of-network coverage control; Medicare Advantage and Medicaid are outside this row

STEP BY STEP

Read date: 10-09-2026

Confirm that MedCost Benefit Services is the claims payer shown by the plan. A MedCost network logo alone does not establish that MedCost administers the claim. MedCost 2026 ID-card guidance
Sign in to the MedCost Member account and use eForms to submit the out-of-network medical claim. Portal upload YES. UNREADABLE: the exact post-login menu, fields, file types, limits, grouping, and confirmation. MedCost claims forms
If using the public PDF, complete Statement of Medical Claim MBS-010. Complete the member page, then have the provider complete the embedded Health Insurance Claim Form or attach an itemized bill instead. A superbill is not expressly named. MedCost Statement of Medical Claim
Sign the employee and patient authorization fields. Sign the separate direct-payment authorization only to ask MedCost to pay the provider. NOT PUBLISHED: the default payment recipient if assignment is not signed or whether a typed or electronic signature is accepted. MedCost Statement of Medical Claim
NOT PUBLISHED: the fields required on the alternative itemized bill, a universal member filing deadline, a claim processing time, or a different behavioral-health member claim portal. The employer's Summary Plan Description and claims payer control. MedCost claims forms
Check claim history and EOBs in the MedCost Member account or open Recent Claims in the My MedCost app. MedCost member claims My MedCost app

Portal upload: YES
Portal: MedCost Member account
Portal path: Log in to the Member account > eForms; the exact post-login claim form and controls are UNREADABLE
Mail address: MedCost Benefit Services d/b/a MBS Third Party Administrators in California, P.O. Box 25987, Winston-Salem, NC 27114-5987
Fax: (336) 774-4420
Attach: NOT PUBLISHED: the form permits an itemized bill instead of the provider page but does not enumerate required itemized-bill fields
File types: NOT PUBLISHED
File size limit: NOT PUBLISHED
Maximum files: NOT PUBLISHED
One file or separate files: NOT PUBLISHED
Confirmation: NOT PUBLISHED
Status check: MedCost Member account > Claims history and EOBs; My MedCost app > Recent Claims
Processing time: NOT PUBLISHED
Member deadline: NOT PUBLISHED
Deadline basis: Most MedCost Benefit Services plans are self-funded; the Summary Plan Description and claims payer on the ID card control
Mental health route: No distinct public mental-health member claim portal is published; the plan document and administrator on the ID card control

Confirm the address, fax number or portal path on the insurer's own claims page before you send; read on 10-09-2026.

Read on 10-09-2026 from https://www.medcost.com/sites/default/files/2018-05/statementmedicalclaim.pdf. Confirm the address, fax number or portal path on the insurer's own claims page before you send.