ClaimLinx claims report schedule

2022 Claims Report Schedule Available

The Claims Report Schedule for 2022 is ready for administrators to review. Click to download the report: ClaimLinx report_schedule2022.

What is the Claims Report Schedule?

This is the schedule the billing department uses when invoicing clients for claims. Once ClaimLinx receives the funds for the claims processed within the period detailed in the report, the billing department begins processing payment for those claims.

Administrators should refer to this document throughout the year to see when to expect an invoice for claims. Administrators can also use it as a basic outline for the beginning of the claims payment process. Remember, ClaimLinx invoices based on the Process Date, not on the Received Date nor on the Date of Service. That is why it’s very important for members to send claims documentation as soon as possible.

What is a claim’s Process Date?

The Process Date is the date a claims processor reviewed and adjudicated a claim. It is the date the claims is processed into the ClaimLinx system. Members and administrators should allow 5-10 business days for processing after the date the claim was received. The maximum time a claim can take for processing is 90 days.

Members should send all claim documentation as soon as possible to ensure timely processing and payment, if applicable. For the best results, members should send the Explanation of Benefits from their primary insurance carrier AND the bill from the providers office. You may contact our claims team for questions regarding a claim or proper documentation. Contact help@claimlinx.com or start chatting now by clicking the button in the bottom right corner of the page.

What happens after ClaimLinx sends the Invoice?

After administrators receive the invoice, ClaimLinx awaits payment before paying claims. Our billing team expects payment for claims in the form detailed in your company’s contract. We accept payment via ACH, credit card, wire transfer, check and prefunding. If you would like to change how you pay your claims invoice, contact service@claimlinx.com. We are happy to talk to administrators about what the best option is for their company.

Please remember, any delays in payment for a claims invoice causes a delay in sending payment to providers and/or members. See more about the entire claims process, from start to finish.

New Client Service Manager Amy McDonald

We are excited to announce a new addition to the ClaimLinx team!

Amy McDonald is our new Client Services Manager. She has over 26 years of experience primarily working with clients in the Professional Employer Organization Industry as Director of Client Relations. She brings a wealth of knowledge on education, problem solving and best practices to ClaimLinx.

Amy oversees all operations of the Service Department and is in charge of all escalated issues, client retention and customer experience. She also supervises the Field Managers, Eligibility Specialist and Client Coordinator. Your Field Manager will still be the first point of contact in servicing your account. Amy will be reaching out personally to introduce herself.

Amy’s contact information is below. Feel free to reach out to her.

Amy McDonald

Client Service Manager
Phone: 513-985-4466
Email: amcdonald@claimlinx.com

claimlinx-health-insurance

Reasons To Choose Claimlinx For Health Insurance In Ohio

Claimlinx Insurance Options 

There are a variety of options that you can use to meet your insurance needs, no matter what your family situation and budget. Here are just a few of the most popular plans Claimlinx can help you get for your business, along with their benefits. 

Flexible Spending Accounts (FSAs) is the plan in which you and your employer will be able to save tax-free money to cover health care. Money can be deducted from your salary if you want to.

According to the rules for the employer, He is not going to be able to transfer any unused funds to the next year. You can extend it to a certain amount.

Claimlinx provided amazing services to its customers to help them with deposits, withdrawals, and other necessary issues and assistance. 

February 18, 2021. The Internal Revenue Service has provided employers with the option to transfer any unused amounts from 2020 and 2021 within an FSA plan due to the pandemic. They can also change the extension of the exposure period, the FSA plan year 2020, 2021, allow the retirement of the FSA plan to be eliminated, and leave in the middle of the year.

Health savings accounts (HSAs) are similar to FSAS, but the money is only to be used for medical expenses. People also use this account to raise money. The advantage of this is that you can still save money on a tax-deductible, as well as the use of lower-cost health insurance to high-risk. Insurance premiums for HSA plans are not taxable.

Health Reimbursement Agreement (HRA) plans are available to employers who can’t afford to get all the health benefits, but it provides some support to the health services providers. Employees will be paid by a pre-determined amount of money for special medical expenses for themselves and their families. The reimbursement of expenses for professional medical care is not subjected to tax.

The Health care Organization to Plan (HPO) provides comprehensive health care at a low cost by allowing participants to make use of the health care providers in the healthcare organization. The cost savings from the HMO plans can be significantly high.

A Preferred Provider Organization (PPO) plan is similar but has a bit more flexibility. With a PPO, you can go out health care organization for service, although a smaller proportion of the costs will be covered if you have to do it. 

 

Services for Our Members

Claimlyix has a wide range of services for its clients. On the website, you will find the answers to all your questions, and find out the cost of a medical procedure, details of your subscription, you can make changes to your coverage plan, you can check the status of your application, find out the status of your account, you will get a replacement member ID card to gain access to all of the benefits and services to you. 

 

 

Cash in on savings on prescriptions

Consultants look at drug costs to find savings

ClaimLinx analyzes each company’s drug usage to find cost-cutting measures. First, it saves employers money. Most importantly, it helps workers be able to afford the medications they need consistently.

Why ClaimLinx Focuses on Rx Costs

Medications are one of the most important tools people have to maintain their health. However, prescription drug costs keep rising each year. By the end of last year, more than 20 generic drugs had a price increase of 29.4%. Also last year, the cost of more than 1,200 drugs rose by 5-6%. It’s a trend that has so far continued into 2021.

What research has shown is that when medication are expensive, people do not fill the prescription or do not do so consistently. In fact, between 20-30% of prescriptions are never filled because of costs. Up to 50% of medications for chronic illnesses are not taken consistently because they’re too expensive. That all adds up to a real impact on members’ health.

That’s why ClaimLinx prioritizes savings on prescriptions. We know it’s important for employees to take their medications consistently to be productive at work. We also know employers don’t have endless funds for drug coverage. To help with that, we focus on finding a balance between the two.

How ClamLinx Saves on Prescriptions

Our consultants get real-time data on prescription usage through our partner pharmacy benefit managers (PBM). Unlike with a standard insurance plan, ClaimLinx sets up a prescription drug plan with a PBM we trust. That allows our consultants to see which medications workers need and how much they cost. From there, our service team has many methods they can use to cut costs on prescriptions. That saves money for both the employer and the employee.

Enrolling in drug coupon programs

One of the ways ClaimLinx cuts costs on prescriptions is by researching drug programs and coupons for medications. These are many coupon programs through the manufacturers and through different pharmacies. There are also cost sharing programs available for those with financial need. We seek these out because they help the employer. But more importantly, they help the employee afford the drugs they need to stay healthy.

Moving members to a new plan

Another cost-saving measure is to move certain members on the plan to new health insurance plans with more prescription coverage or discounts. For some members, it makes more sense for them to be on a more comprehensive plan. The plan may be higher cost, but it will save in the long run if the drugs are expensive. Our agents are seasoned in taking this into account when finding members the plan that’s going to work best.

Finding generic version of drugs

As a part of ClaimLinx’s overall solution, we place an emphasis on educating members on costs so they can be good healthcare consumers. To help with that, we recommend members have an open dialogue with their providers about their prescriptions. We tell members to ask their doctors if they have chosen a brand name drug why that is. Is there an alternative that can achieve the same results. We also help workers research generic versions of brand name drugs, if they are available. Sometimes providers are unaware of the costs of prescriptions so it’s important to talk with them when the drugs are expensive.

Shows Schedule of Benefits at work

ClaimLinx customizes every client’s Schedule of Benefits

Every ClaimLinx client receives a custom schedule of benefits. ClaimLinx experts design it to fit the company’s needs, usage and budget. That is flexibility in plan design you can’t find anywhere else.

What is a Schedule of Benefits (SOB)

A Schedule of Benefits, or SOB, is a list of the services a health plan covers. It’s a record of the fees a member will be charged for certain standard services. Members receive an SOB at the beginning of their policy. It shows what treatments will be covered and at what dollar amount or percentage they will be covered. That way members know about how much the visit will cost before they arrive.

How ClaimLinx customizes SOBs

For any company that chooses the ClaimLinx Simple Option Solution, one of our expert consultants creates a custom SOB. For new clients, we typically base the first SOB on the company’s previous plan. That way there’s no disruption in coverage or benefits. It’s a seamless transition from a client’s old plan to the ClaimLinx Solution.

After the client has made the transition, our consultants look at usage throughout the year. That’s because ClamLinx is a third-party administrator. That means we process the claims in-house. This allows us to see how members are using the plan in real time. Using that information, our consultants can make adjustments to help the plan work better. With regular group insurance, employers never see how much their workers are using the plan. But with ClaimLinx, we’re able to tell you what services members are using. That way, we can tell you what changes to make to either cut costs or improve benefits.

Because the plan is not through a big insurance company, it does not have to fit a certain mold. We can change how much a member pays for specific services without having to change the entire plan. Also because this is all done in-house, it can be done quickly, even before renewal.  You will not find more flexibility in a health plan.

Why custom benefits are better

Being able to customize the health plan helps companies make sure budget and and benefit goals are in sync. Because our consultants can see actual plan usage, they can tell clients where they may be able to adjust the plan to lower costs. For example, we often see companies that have a lot of emergency room claims, which tend to be very expensive. In this scenario, we recommend raising the cost of those claims to the employee and lowering the cost of urgent care visits. That way, members are being taught and encouraged to find lower costs alternatives to going straight to the emergency room.

Custom benefits are also great because they can be adjusted to reflect your company’s specific needs and/or demographics. For example, a company with a lot of families may want to make sure the cost of office visits stays low to ensure children and parents can afford preventative care visits. Or, alternatively, a company with a lot of older employees may want to cover more testing procedures or prescription medications to help works afford to manage any chronic conditions they may have.

There is so much our consultants can do to make sure the health plan is working for everyone. It doesn’t have to break the bank. And at the end of the day, having healthy employees improves productivity for the company. That’s happy for everyone.