Tips For Helping Members With Claims Issues

Administrators for the Medical Expense Reimbursement Plan (MERP) sometimes have members reach out with problems or questions regarding their claims.

Here are some tips to give employees if they have questions or issues with the claims process:

  • Be proactive – Remind members to check their primary insurance network and any required preauthorization before a procedure or appointment. Changes to networks or primary insurance carrier’s policies can be made at any time during the year.
  • Check during processing – A claim goes through many steps before a provider or facility receives payment – see the attached step-by-step diagram – and it’s important to follow all claims throughout this process. Members can check claim status at any time using the ClaimLinx member portal by going to http://www.ClaimLinx.com and clicking the green “Member Login” button.
  • Communicate with provider billing – Some provider billing departments have short timelines as to when they begin pursuing patients for payment. If a member is receiving calls from a provider billing department and is waiting for a claim to be processed, he or she can explain this to the office to be noted on the claim.
  • Be patient – The process can sometimes take time, which can be frustrating. But it’s important for members to remember there are many resources to help, including the the claims department at your primary insurance carrier and at ClaimLinx. Members may contact the claims department at any time by emailing help@claimlinx.com.

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