Step-By-Step How A Claim Is Processed At ClaimLinx

There are a lot of positives to your employer choosing to switch to the ClaimLinx strategy of providing group health insurance:

  • You receive personal service regarding your benefits
  • Your employer can customize benefits to fit company needs
  • The company saves money when buying health insurance

But, if your employer has recently instituted a Medical Expense Reimbursement Plan for the first time, you may be confused about how your claims are actually paid. Check out our flowchart explaining the process, or see the steps below.

The entire process typically takes 30-60 days, from the date of service to when ClaimLinx sends payment to the health care provider.

Step 1 – Visit your physician

– The process begins when you visit your health care provider.

– Most important during this step is that you show BOTH your primary insurance ID card and your secondary ClaimLinx ID card.

Step 2 – Your provider bills your primary insurance

– Once your visit is over, your health care provider submits the bill to your primary insurance carrier.

– Your primary insurance carrier then determines your coverage and sends an Explanation of Benefits (EOB) to you and your health care provider.

Step 3 – Submit information to ClaimLinx

– In many cases, your primary insurance carrier will not have paid the entire bill for your visit. That’s OK; you still have secondary insurance.

– Now, you and/or your health care provider will need to submit the claim, bill and/or primary carrier EOB to ClaimLinx to be processed for additional coverage.

Step 4 – ClaimLinx processes your claim and sends your physician any applicable benefit

– Once ClaimLinx receives all of the correct information, our claims processing team determines any additional coverage from the Medical Expense Reimbursement Plan (MERP).

– ClaimLinx then submits any balance for applicable MERP benefit to your employer.

– Your employer pays ClaimLinx for this balance, and ClaimLinx sends a check to your health care provider

Step 5 – You receive a ClaimLinx EOB

– Once MERP coverage has been determined, ClaimLinx sends you an EOB.

– The ClaimLinx EOB will show any remaining balance you will need to pay your health care provider.

– If there is a remaining balance, you will need to send payment directly to your provider’s billing department.

You can also improve this process by sending ClaimLinx a list of your physicians. You can send the list by mail, fax or email to help@claimlinx.com. Once we have this, we send information to the physician’s office to introduce our company and explain the process.

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