- Is there a time limit on filing a claim?
- You or your provider should file your claim form as soon as possible after receiving a service. The normal filing period is within 90 days of the date of service. No claim filed more than 15 months after the date of service will be considered for payment by the Plan. Responsibility for correctly filing claims is yours. Call your provider if a claim has not been paid after 90 days.
- How long does it take for a claim to be processed?
- Allied processes 90 percent of claims within ten business days of receiving the claim. If a claim is pended for more information, it will depend on how quickly the requested information is received by Allied.
Each provider or hospital has different billing cycles and systems. A physician's office may bill at the time of service or once a month. A hospital may bill at the end of a stay or after they have received all the services and items rendered from each department for the patient. Some hospital invoices have been received up to three months after the date of service.
If Allied has not received your claim within three months of the service date, you should call the provider and verify that they have the correct address and ask them to mail the claim to Allied. Allied also accepts electronic claim submission.
- I am a new employee. I do not have an ID card yet. How do I get medical and prescription claims paid?
- Prescription Claim: You need to pay the full price and save your receipt. After you receive your ID card, send a copy of your receipt with a completed Express Scripts Prescription Drug claim form to the Express Scripts address for reimbursement consideration. The form can be downloaded from the Forms page.
Medical Claim: Before you receive your medical ID card, a provider may verify that you were hired and have medical coverage with your school district by calling your employer's office. After you receive your ID card, your provider may call Allied customer service at 1-800-288-2078 to verify eligibility and benefits.
- How are payments made for an in-network provider?
- Your in-network copay is based on the negotiated pricing of the Preferred Provider Network. Your copayment is calculated on the net price negotiated (after the discount is applied). Your provider may not bill you for any amount over the negotiated fee.
- How are payments made for an out-of-network doctor?
- If you use an out-of-network provider, you will pay the higher out-of-network copay. If your actual charges are more than usual and customary charges (U&C), you will be responsible for paying the difference between the provider's charge and U&C. If you have an annual out-of-pocket maximum, the U&C deducted amount does not count toward your annual out-of-pocket copayment maximum limits.
Remember there is no "balance billing" when you choose an in-network provider. You do not need a referral to in-network providers.
- Can my doctor collect my copay at the time of service?
- Yes, but be sure to check your Explanation of Benefits from Allied to be sure you were charged the correct amount.
- What is Coordination of Benefits (COB)?
- Many families are covered by more than one health plan. The COB process determines which plan pays first for your family's health care. BHP will coordinate benefits with other group medical plans that cover your dependents.
To find out if your health plan is your primary or secondary source of coverage, please read the COB section in your Medical Plan Book or contact Allied.
- BHP is the secondary payor to my spouse's medical insurance, how do I file a claim?
- Prescription Claim: Send a copy of the receipt and a copy of your spouse's Explanation of Prescription Benefits (EOPB) with an Express Scripts Prescription Drug Claim Form. Forms can be download from the Forms page.
Medical Claim: Often, the provider will bill the secondary payor for you. If they will only bill the primary insurer, you may send an itemized bill and a copy of the Explanation of Benefits (EOB) from your primary medical insurance with an Allied Medical claim Form to the Allied address. Your employer's office has the claim forms or forms can be downloaded from the Forms page.
- Understanding your Explanation of Benefits (EOB)
- Your provider sends your claims to Allied and Allied then sends you a medical or dental EOB each month listing your claims. This form explains the total amount billed, the amount paid, and who was paid. If any further information is needed, this request will also appear on the form. Please review this form carefully each time you file a claim so you will understand how your claim has been processed. You may view your EOB on the Allied website. View How To Read EOB.
- What are the most common reasons a claim may be pending?
- Over ninety percent of all claims sent to Allied will be processed within ten business days; however, some claims are pended or delayed for more information. If Allied needs more information and the Claims Representative cannot obtain this information from a phone call, a copy of the EOB will be sent to the provider and employee member. The remark code will be printed at the bottom of your EOB.
The most common reasons are:
- Other Insurance Information
- Pre-Existing Information
- Accident Information
- Prognosis
If you do not understand your EOB, contact Allied for an explanation.
- How do I know if claim is paid?
- You may check the status of a claim by:
1) Reviewing your Explanation of Benefits (EOB)
2) If you have not received or have misplaced an EOB, you may visit the Allied web site to check claims status or print a duplicate EOB
3) Allied Customer Service is available Monday - Thursday 8:30 a.m. to 8:00 p.m. Friday 9:00 a.m. to 6:00 p.m., and Saturday 10:00 a.m. to 1:00 p.m. (EST) except for holidays.
For faster service, have the covered employee's ID card or social security number, patient's name, and the date of service ready.
4) To check status of a claim, call Allied. Do not call HealthSpan, the PPO.
- What if I find a medical billing error? The Check and Share Program.
- If you find a medical billing error and have it corrected, we will share the difference between the original charge and correct amount with you. The Plan will pay you 50% of the saved amount up to a maximum of $1,000. You will get a check when the money is retrieved from the provider.
Here is how the Check and Share Program Works:
Each time you receive care, service or treatment (other than prescription drugs), be sure to get an itemized bill. Check the charges carefully to be sure that you actually received all the care or items listed on the bill and compare to your EOB. If you find a mistake in the amount billed or if you did not actually receive all of the care or items listed, take your bill to the hospital, your doctor, or the store where you bought the covered items and ask for a corrected bill. Send a copy of the original bill and the corrected one to Allied. After verifying that you qualify and the money is retrieved, the Claim Payor, Allied Benefits Systems, will send you a check for 50% of the difference between the erroneous and correct amounts, up to a maximum of $1,000.
