It is important that your office notify MedCost of any changes in demographic information prior to the effective date of the change. Examples of key demographic information include Tax ID, NPI, Provider Name, Practice Name, and Practice Address. Having accurate information in our system will help ensure that claims are processed correctly and promptly. This also will enable us to provide the most current information to patients and claim administrators.

For any changes that you may have, please complete the form below.

Practice/Facility Information *Indicates required field

Contact Name*
Contact Phone or Email Address*
Provider Name
CAQH ID
Practice/Facility Name*
Current Tax ID*
Credentialing Contact Name*
Credentialing Contact Email Address*
Practice Email Address
Group NPI*
Individual NPI*
Type of Change(s)
Effective Date of Change*
New Tax ID
Old Tax ID
New Address (Indicate Main or Billing)
Old Address
New Provider Name Change
Previous Provider Name
New Practice Name Change
Previous Practice Name
New Phone Number
Previous Phone Number
Miscellaneous Changes/Updates