FAQs for Medical Claims Processing

You have Questions. We have the Answers.

Below are questions we are frequently asked. Simply Click on the question and you will see our answer. If after reading the answers in this section, you still have unanswered questions, please contact CHC HERE.

Questions and Answers

Answer: When CHC receives your completed Medical Claim Form and the Medical Claim Documents, CHC will assign a CHC Concierge to help you manage your Medical Claim. The CHC Concierge will: (a) review your Medical Claim Form and submitted medical bills for possible errors, costs and treatment questions., (b) determine your Benefits and Coverages according to this Agreement, (c) apply the Medical Claim Limitations and Medical Claim Requirements, and (d) check payment and reimbursement options. At the same time, CHC starts processing your Medical Claim.

During the CHC Processing, CHC Processing may have questions or need additional documentation. In this event, you will see the request on the EOB or you will be sent a CHC Medical Claim Request for Information form. Please promptly respond with all requested information. Not responding within 30 days of the sending date can be grounds for canceling or denying the Medical Claim.

For Non-Routine Medical Services, the CHC Concierge will attempt cost reductions and to establish payment terms with the Medical Providers.

There is no guarantee that the CHC Concierge will be successful in lowering your medical bills, medical costs or establishing a medical bill payment program.

Upon completion of the Medical Claim processing, CHC will determine the approved Medical Claim Reimbursement Amount, if any; (the "Reimbursement Amount").

Answer: For a Routine Medical Service claim the time frame is usually less than 30 days. For a Non-Routine Medical Service claim, the time frame may be longer. The processing time varies based on: (a) the promptness and completeness of the submitted Medical Claim Documents, (b) the CHC Concierge review of the Medical Claim Documents, (c) the complexity of the Medical Claim and (d) any interaction with the Medical Providers.

Answer: The Co-Pay Payment is due and payable when your Medical Claim is processed. The Co-Pay Payment will be paid: (a) first, by a draw upon your CHSA, then (b) a reduction in the Reimbursement Amount. In some cases, CHC may ask for you to make an independent Co-Pay payment.

Answer: Your EOB tells you the estimated date your Reimbursement check will arrive.

If you paid the medical bill, the Reimbursement comes to you. Otherwise, the Medical Provider will be paid based on the payment agreement between you, CHC and the Medical Provider.

The Reimbursement amount will be sent to by check from either 1st Bank or the Elevations Credit Union. For certain Medical Claims, CHC may elect the Reimbursements to be sent in multiple payments using multiple checks.

Answer: Your CHC Reimbursement Amount is first drawn from your CHSA. If your CHSA Account Balance is insufficient, the remaining CHC Reimbursement Amount is drawn from the CHC Matching Account. If the CHC Matching Account is insufficient to pay the remaining Reimbursement Amount, the remaining Reimbursement Amount will be paid from your Medical LOC up to your Medical LOC Benefit Amount.

Answer: The EOB contains information on the processing of your Medical Claim. Within approximately fifteen days of receiving your Medical Claim Documents, the CHC Concierge will respond by sending you an EOB. Each EOB will show each Medical Sub-Claim received. Page 2 of the EOB has definitions and explanations.

For a Medical Claim, there may be more than one EOB, as needed, to show all Medical Sub-Claims. An EOB will be sent for each Medical Processing event relating to a change or update of the Medical Claim.

The EOB describes how your Medical Claims are paid, Account Balances, and other financial information. The EOB also includes notes in the “Claim Notes” section. Please read. Additional information may be required to process your medical Claim.

If you notice on the EOB a missing medical claim or you disagree with any item on the EOB, immediately contact the CHC Concierge. Your Medical Claim becomes final on the date shown on the EOB "Closed Date". After the Closed Date, a Medical Claim may not be reviewed or adjusted unless the Medical Claim or any Medical Sub-Claim shows "Pending