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.
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 firstname.lastname@example.org.
Some of this information was taken from an article which featured our partner, Medical Cost Advocate, published in Employer Benefit News. Read the article.
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 email@example.com.
ClaimLinx is pleased to announce to all of its clients that we have added a resource for individuals looking for coverage on the insurance market – www.ClaimLinxMarketplace.com.
This site is a one-stop shop for those looking to purchase an individual plan for themselves to:
- See off-exchange insurance plans, which can have broader hospital and physicians networks and additional benefit options.
- Easily compare pricing and plan options available through the individual market and through the federal exchange.
- Speak to an insurance agent to complete the application process and discuss options.
- Find additional insurance coverage such as vision, supplemental and life insurance.
Please feel free to share this resource with any friends or family looking for individual coverage during this year’s open enrollment period. Just tell them to go to www.ClaimLinxMarketplace.com to get started.
As a member or administrator for a ClaimLinx plan, you will continue to receive the personalized service and/or benefits through the employer-sponsored plan. This is an additional resource for those who do not receive coverage through an employer.
Having an energetic and effective staff isn’t always just about providing good health insurance benefits.
At ClaimLinx, we have seen even our own employees health and productivity affected by the stress of their work. That’s why this year we had each of our employees attend a Ritemind Stress Less Workshop.
Through these private online sessions, our whole team learned how to identify and cope with stress in more productive ways, a vital tool as we all move into the busier season of Fall and the holidays.
We encourage all of our clients to use their savings to invest in employees through programs like these. Please see the information sheet about their sessions and the workshop.
If you have any questions about the program, please contact Laurie Althaus by email at firstname.lastname@example.org or by phone at (513) 703-3891.