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.

Related Post: ClaimLinx Glossary: Medical Expense Reimbursement Plan (MERP)

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 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

Related Post: ClaimLinx Changes Claims Negotiator

Members Can View EOBs on the ClaimLinx 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

Related Post: How to file a medical claim

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 to check on its status.

Related Post: Step-By-Step How a Claim Is Processed at ClaimLinx

What is the ClaimLinx Simple Option Solution?

The ClaimLinx Simple Option Solution is ClaimLinx’s premier product. It’s our trailblazing solution for purchasing employer-paid benefits at a lower cost.

In the simplest terms, the ClaimLinx Simple Option Solution plan combines a high-deductible insurance plan with a self-funded medical expense reimbursement plan (MERP). It’s taking a regular health insurance plan and mixing it with a self-funded plan to get the best option for employers and workers.

Related Post: What Is a Deductible?

Start with a High Deductible Plan

The high-deductible health insurance plan offers peace of mind. That way the insurance company is responsible for the bulk of bill if an employees has high medical costs. The regular health insurance plan also offers a wide doctors network. That way employees can keep going to the same doctor, specialist or hospital.

Insurance carriers also have contracts for discounts for certain services. With a high-deductible plan, employers and employees can use those discounts to lower the amount for services. The best part is by choosing a high-deductible plan, employers get both of these benefits — a wide network and discounts — at a much lower price.

Then Add a Self-Funded MERP

The problem with a high-deductible plan is it doesn’t have as many important benefits employees need. That’s why we add back the self-funded medical expense reimbursement plan (MERP). ClaimLinx designs each plan to fit the clients needs. We typically mirror the plan employees are currently using. That means workers experience the same deductible and copays. They don’t see a change in their benefits.

That’s all because the MERP, which the company funds, pays for the gap between the high deductible plan and the self-funded plan. We take all that savings on insurance premiums from choosing a high-deductible and bring it back to the employees so they still have great benefits.

Related Post: ClaimLinx Glossary: Medical Expense Reimbursement Plan (MERP)

The ClaimLinx Solution Includes Processing

ClaimLinx is a quality third party administrator. We provide customized service for all medical claims for the self-funded MERP.  It’s a simple process combining the two types of insurance, and it’s all done in-house. First, each claim goes to the insurance carrier of the high-deductible plan. Then it is sent to ClaimLinx, where our experienced processors determine who owes what on any remaining amount for the claim.

Our team takes care of billing the employer and even sends payment directly to providers. We focus on giving each client the same seamless experience as having a traditional plan with a major carrier. See the process at work.

The ClaimLinx Solution Fits You

The ClaimLinx Simple Option Solution plan is different for each client. The self-funded plan is customized for each company. ClaimLinx chooses each high-deductible to fit each clients specific needs. It’s a way to provide great benefits without paying high premiums to a health insurance company for services employees are not using.