How to file a medical claim

Note: The below information is also listed in our member packets. Download your member packet now for more information like it about your plan. 

The first step for filing a medical claim for a ClaimLinx SOS Solution Plan is to show two ID cards when you visit your medical provider:

1. Major medical insurance company ID card as primary coverage
   • Example: Anthem, Humana, Harvard Pilgrim, Cigna, National General, etc.
2. ClaimLinx employer funded ID card as secondary coverage

Most providers will file claims with secondary coverage. However, if the provider does not file secondary or if you receive information at your home, send any of the following items by mail or email to help@claimlinx.com to assist us in processing your claim.

1. Major medical carrier Explanation of benefits (EOB)
   • This document is usually received about a month after a visit with a provider and has the discounted bill amount. It will come from your primary insurance coverage company (Anthem, Humana, Harvard Pilgrim, Nation General, etc.).
2. Documentation with diagnostic coding
   • Sent by the provider, diagnostic coding explains the services performed or any diagnostic informaiton. You can also ask for this when you leave your provider’s facility.
3. Information about the provider
   • Especially important information is the phone number to reach the physical address and billing office. You may write this on any information you send or fill out a Provider Information Form.
4. Invoices (not statements)
   • Invoices have detailed billing information, your account number, claimant name and diagnostics. Statements do not provide any additional information for processing.

Claims are processed within 10-15 business days. You can see the full process a claim goes through once it is received at ClaimLinx. You may download an explanation of benefits for your claim once it has been processed on the member portal.

Please note that if ClaimLinx is missing any information or is waiting on requested documents, a claim will take longer to process.

If you paid up front for any services you can request a reimbursement for the services. First, you must fill out the medical expense reimbursement claim form. Then send this form with a receipt indicating you paid for the services. This can include a credit card statement, receipt from a doctor’s office, pharmacy receipt, processed beck front and back or any other proof of payment. No services can be reimbursed without this information.