What is a claim?
A health insurance claim is a formal request for an insurer to pay for services. A provider office may submit a claim for you. Or patients can submit claims directly.
How many days does processing a claim take?
The claim’s processing time is typically 5 to 10 days from the received date. It could take longer if ClaimLinx has not received all the needed documents to process the claim.
Once all the documents are received and the claim is processed, it usually takes about 30 to 40 days for a check to be issued. In total, the process takes on average 35-60 days from the date ClaimLinx receives the claim.
What is involved in the process?
Claims go through many steps before a check is issued. Once ClaimLinx receives the claim, a qualified claims processor checks the documents, enters the claim information, and analyzes it for the correct benefit application.
You can see the remaining steps following adjudication on this detailed diagram. ClaimLinx coordinates directly with employers to ensure payment is as seamless as possible.
Why could a claim be delayed?
Claims are delayed if ClaimLinx, as the secondary payer, does not receive all the necessary documents to process a claim.
When a provider submits a claim, it must send the claim form and the primary insurance Explanation of Benefits (EOB).
If a member is submitting a claim, he or she must submit the primary insurance EOB and the itemized statement from the provider. When a member has paid a claim in full, ClaimLinx will need proof of payment to process any reimbursement.
What can you do to speed up the process?
There are steps members can take to expedite the process. Members should present both cards to the provider at the time of the visit – the primary insurance ID card and the ClaimLinx ID card.
If the provider has additional questions regarding the ClaimLinx claims process, they can call our customer service line 800-858-1772.
Members are welcome to submit claims on their own by emailing our the claims department at firstname.lastname@example.org. Be sure to send a copy of the primary insurance EOB and an itemized statement.
How to contact our claims department?
A member or provider can contact the claims department during regular business hours by calling 800-858-1772 or emailing email@example.com.
You can also chat with a live person during business hours using our online chat feature. Just go to Claimlinx.com/livechat.
Claims can be submitted via email, fax, or mail. The member ID card also includes this information.