How a claim is processed

See below the steps a claim goes through as it is processed. Claims are processed within 10-15 business days of their receipt at ClaimLinx. Members can view their Explanation of Benefits (EOB) once it has been processed through the member portal.

Once the claim has been processed and coverage has been determined, additional steps are taken before payment is sent to the provider (detailed below). If you have any questions about the process or a specific claim, contact our team at help@claimlinx.com.

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ClaimLinx Individual Marketplace Available For Open Enrollment

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.

Members Can View EOBs On The Portal

Did you know ClaimLinx members can check their medical claims’ status online? All they have to do is login to the private portal:

  1. Click the green “Member Login” button at the top of this page
  2. Follow the instructions on the left of the page for login information

The portal is the perfect place for members to get real time access to the claims processing system. Once logged in, they can view current versions of any Explanation of Benefits (EOB) for a claim.

We encourage all of our members to take an active role in making sure their claims are processed, and this is a good way to check on their progress. If a member does not see an EOB, he or she can contact the claims department at help@claimlinx.com to check on its status.

Use The ClaimLinx Prescription Savings Card

We have seen how much prescriptions costs are rising for all of our members. So we have been sending prescriptions savings cards (see above) to members along with their Explanation of Benefits (EOB).

See the sample of the insert members have been receiving with the ClaimLinx Prescription Savings Card.

Why does this savings card benefit members?

  • Big discounts – The price for 80% of the most used generic drugs is lower with the card than insurance copays of $10 or more.
  • Easy to use – Members just have to give the card to the pharmacist to start receiving discounts.

The exclusive ClaimLinx prescription savings card can be ordered by emailing help@claimlinx.com or by following the instructions on the insert.

ClaimLinx Changes Claims Negotiator

A vital part of ClaimLinx’s claims processing services is that all high dollar claims are sent for review and/or negotiation through a third party.

This is a seamless process we provide for all our clients to make sure all claims are filed correctly and that our clients are receiving the maximum savings possible.

ClaimLinx recently transitioned this task from Copatient to our new partner, Medical Cost Advocate (MCA). This change has already become effective, with no interruption or change to clients’ claims processing. Please see how a claim is processed for how MCA is involved in the claims process.

We are very happy to be working with MCA. They have more than 10 years of experience in negotiating medical expenses and we are excited to share that savings with you.