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Have a Question: First, check a Blue Bar. Next, check out the FAQs. Click the Hug "FAQs" to see the Frequently Asked Questions. If you still have a question, Click the Hug "Contact Us" and send us your question.
File a Medical Claim: Please read "How to file a Medical Claim". Then Click the "Start a Medical Claim" HUG.
The CHC Medical Claim Form: The CHC Medical Claim Form describes the Medical Event causing the need for a Medical Service. A completed Medical Claim Form is required to process any Medical Claim. Failure to provide a Medical Claim Form will cause a delay or even a denial of your Medical Claim.
Required Medical Service Documents: The Medical Services Documents should be given to you when you check-out. If not, please ask for them.
Each of the following documents must be sent to CHC with your Medical Claim Form. Each document must in a legible, paper, PDF or .jpg format.
A Statement of Services (SOS): The SOS describes each performed Medical Service. The SOS may have other names and may include multiple documents. For instance, it may be called the Intake Report or Initial Physician’s Report.
The SOS must describe; (a) the initial medical analysis performed by each Medical Provider, (b) the description of the cause for the Medical Event, (c) the Medical Services performed, and (d) discharge notes.
For Routine Medical Services: Usually there is one Statement of Services and one bill from one Medical Provider. For an annual wellness there may be an additional Lab and Test bill.
For Non-Routine Medical Services: Usually there is more than one Medical Provider. Each Medical Provider’s Statement of Services and medical bill is treated separately when processing your entire Medical Claim. Frequently the Medical Provider’s Medical Claim Documents will be received by you at different times. Send the Medical Claim Documents to CHC when received. CHC will process each when received, thereby speeding up your reimbursement.
A Billing Statement: The Billing Statement shows the itemized cost for each medical treatment provided by the Medical Provider including CPT codes and any adjustment in the cost for Self-Pay and other discounts.
Payment Receipt: A copy of your payment receipt (credit or debit card) or other evidence showing your payment at the time of the Medical Service or the amount owed to the Medical Provider.
Send your Medical Claim Form & Documents to CHC: Email - Concierge@CHCHealcare.org. Postal - Community Healthcare Cooperative PO Box 267 Morrison, CO 80465.
Processing Time: About 5 days from receiving your Medical Claim Form and Documents.
Your Reimbursement: Will be sent to you by paper check from one of our affiliated banks.
Your CHC Concierge Services: Your CHC Concierge is your Healthcare Advocate. If you have any questions about your healthcare, locating Medical Providers or just have questions, contact your Concierge. Use our email contact as much as possible. You will get a faster response. If you need to chat, just let us know to call you.
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 Information Request form. Please promptly respond with all requested information.
For certain 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.
Processing Times: 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.
ü The promptness and completeness of the submitted Medical Claim Documents
ü The complexity of the Medical Claim and the Medical Services
ü Any interaction with the Medical Providers
Explanation of Benefits (EOB): The EOB contains information on the processing of your Medical Claim. Page 2 of the EOB has definitions and explanations. An EOB will be sent for each Medical Processing event relating to a change or update of the Medical Claim.
The EOB also describes how your Medical Claims are paid, account balances, and other financial information. The EOB includes notes in the “Claim Notes” section. Please read. Additional information may be required.
EOB Time Frame: Within approximately fifteen days of receiving your Medical Claim Documents, CHC Processing will respond by sending your EOB. Each EOB will show each Medical Sub-Claim received. For a Medical Claim, there may be more than one EOB, as needed, to show all Medical Sub-Claims.
Missing Claims: If you notice on the EOB a missing medical claim or you disagree with any item on the EOB, immediately contact your CHC Concierge.
Important dates: 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 a Medical Sub-Claim shows “Pending”.
If You Paid Your Medical Bill: If you paid in full the medical bills associated with your approved Medical Claim, you will be sent your Reimbursement Check by paper check from one of CHC’s participating banks or credit unions. The date you should receive your Reimbursement Check is shown on your EOB.
If a Payment Plan has been established with a Medical Provider: If a payment plan has been established with one or more Medical Providers and agreed to by you and CHC, CHC will follow the payment plan’s Terms and Conditions for payment of the Reimbursement.
Example: If you selected a $1,000 Co-Pay Max and the approved Medical Claim is $900, your Co-Pay is $450. (The Shared Responsibility 50% times $900 equals $450)
If the approved Medical Claim is $5,000, the Shared Responsibility calculated result is $2,500. Your Co-Pay is limited to only $1,000 because your $1,000 Co-Pay Max is less than the calculated result.
With this unique, two step approach, CHC limits your Out-of-Pocket costs and significantly lowers your financial risk.
For Medical Services: The Medical Claim Documents must be sent to CHC within 30 days of any Medical Service, and 45 days prior to the date of any Future Medical Service.
This requirement is necessary to give CHC time to; (a) review the Medical Service bills, (b) negotiate with the Medical Provider any Self-Pay discounts, or (c) challenge the cost of the Medical Service.
Failure to timely provide these documents may result in a delay in processing your Medical Claim, reduction in the reimbursement amount or a denial of your Medical Claim.
All Medical and Prescription Medication Claims must be filed no later than January 31 for the prior 12 months. Otherwise, the Medical Claim may be denied.
Answer: Any time your Medical Service will cost over $250. Contact CHC for approval.
If you have a Medical Event that requires immediate attention, have the Medical Service. Attempt to avoid paying any medical bill over $250. If needed, have the Medical Provider contact CHC.
Always show your CHC Member ID card at time of service.