Due Date for 1095 Forms Moved to March

Tax filing deadlines are coming up so some of you may have employees asking questions about their 1095 health coverage information forms. Please be advised at the end of last year the Internal Revenue Service (IRS) extended the deadline for issuing these forms to March 2, 2018.

This means insurance carriers and other insurance providers have until this date to provide Forms 1095-B or 1095-C to members. This 30-day extension is automatic and does not require any paperwork to request it.

However, this does not mean that employees are required to wait to receive this information to file their individual income tax return. The IRS states these forms can be used to assist in preparing a return but are not required to file.

As a reminder, these forms are issued from the primary insurance carrier on your plan, not by ClaimLinx. If employees have not received this form after this deadline, they can request it from the insurance carrier directly.

If you have received any additional instructions from your primary insurance carrier regarding these forms, such as if your carrier is National General, please follow their instructions for filing as soon as possible.


Billing errors cost members and employers on services

As many as 80% of medical bills in the United States contain errors, according to Derek Fitteron, CEO of Medical Cost Advocate, a partner of ClaimLinx. And those errors can lead to an unnecessary increase in a bill’s overall cost. In fact the credit agency Equifax reported that for bills totaling $10,000 or more, there is an average error of $1,300.

A big reason these errors occur is the way healthcare providers classify diagnosis, symptoms and procedures. They use a coding system called the ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification). The system is incredibly complex with mistakes leading to patients potentially being charged for procedures or testing they did not receive or more expensive versions of their care.

Errors can occur on any medical bill, but tend to be found on bills for complex medical procedures, inpatient care, care from a medical specialist or when patients receive care at a facility outside their insurance carrier’s network.

To prevent this issue for all ClaimLinx clients with a Medical Expense Reimbursement Plan, any high dollar medical claims are automatically sent to Medical Cost Advocate for review and negotiation. But employees can also help to combat this issue by being sure to check any medical bills for procedures or testing they do not recognize, especially bills totaling over $1,000.

Members should contact their provider first with questions about any bill. Then if a change must be made to a previously processed claim, they can contact the Claims Department at help@claimlinx.com.

Some of this information was taken from an article which featured our partner, Medical Cost Advocate, published in Employer Benefit News. Read the article.


Changes to the phone operating system

Last week ClaimLinx conducted a trial of a change to our customer service phone operator from a local attendant to an auto attendant. We believe this transition will ensure members and administrators will reach their desired departments faster, and with less front-end explanation. 

This change will remain permanent for the foreseeable future. We have already seen an improvement in our call efficiency. We have found members are able to reach the claims department quickly, without having to explain their issue to multiple people.

Below are the options all callers hear when reaching the general ClaimLinx customer service numbers, (800) 858-1772 or (513) 677-6262.

  • Dial 1 – If you are a member or provider’s office calling about claim status, benefits or eligibility
  • Dial 2 – If you are an administrator or broker
  • Dial 3 – If you are in need of insurance
  • Dial 4 – Lisa Grubb, ClaimLinx Health Insurance agent
  • Dial 5 – Kathy Durnell, ClaimLinx Health Insurance agent
  • Dial 6 – To reach accounts receivable
  • Dial 7 – General mailbox

 Administrators and members can still reach specific ClaimLinx team members by dialing their extensions or their direct lines. 

ClaimLinx solves spiking insurance premium problem

View the published press release.

CINCINNATIDec. 13, 2017 /PRNewswire/ — Right now at small businesses all over the country, administrators are making a grim choice – cut benefits for next year’s insurance plan or face strained resources to cover their premium increase.

Premiums for employer-sponsored health benefits for 2018 are expected to be the highest since 2011, according to the human resources consultancy Mercer’s 2017 National Survey of Employer-Sponsored Health Plans.

Blame it on Washington, D.C., blame it on insurance company stakeholders, blame it on anyone who unjustly seems to pull in profits through the industry. It all adds up to one thing: employers and their employees are continuously being asked to pay more to receive less.

But for one company in Cincinnati, this is a problem with a simple solution. ClaimLinx, a full-service consultant, insurance agency and third party administrator, has pioneered new ways of purchasing health insurance so companies can cut costs without sacrificing benefits, such as increasing deductibles or copays.

“Our whole goal is just to save people money on their health insurance – it’s hard sometimes but when we do it’s incredible what it can do for a business,” said Christy Quigley, President of ClaimLinx.

They do this by combining a high deductible insurance plan through a major carrier — Anthem, Humana, Aetna, Cigna — with a self-funded medical expense reimbursement plan.

The trick is to take the best of both types of insurance.

From the plan through a major carrier the company receives resources, including a wide physicians network, competitive discounts on procedures and a stop loss in case any employee has high medical costs.

From the medical expense reimbursement plan the company has the ability to customize its own copays and deductible while still receiving the tax benefits exclusive to a self-funded plan through section 105(b) of the IRS code.

Tom Quigley, National Business Consultant at ClaimLinx, said he sees business owners struggling with decisions about their plan every day when they don’t need to.

“What it really boils down to is a math problem. The problem is it can be hard to take the emotion out but you really have to when it comes to your benefits.”

For more information go to www.claimlinx.com or inquire directly to Whitney Faber at wfaber@claimlinx.com or (617) 892-4655.

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.