How to file a 2007 claim.
If you have an unpaid claim from 2007, show your provider your new ID
card. All claims will be paid by Allied.
Allied Benefit Systems, Inc.
P.O. Box 909786-60690
Chicago, IL 60690
How to file a claim.
All medical claims must include an itemized bill and should be sent to the
claims payor address on the back of your ID card. In-Network providers usually will file the claim for you and bill you for the balance. Your
in-network co-pay is always calculated on the discounted service fee.
Claim filing for Out-of-Network providers or to a secondary insurance is your responsibility.
Allied claim forms are available from your school district's treasurer's
office or click on 'Forms' section of this web site.
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?
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Allied processes 90 percent of claims within 10 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.
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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'm 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
I.D. card, send a copy of your receipt with a Caremark Direct Member
Reimbursement to the Caremark address for reimbursement consideration. Your employer's office has
Caremark claim
forms or you may download the form from the
Caremark
web site.
Medical Claim: Before you receive your medical I.D. 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 co-pay is based on the negotiated pricing of the Preferred Provider Network. Your co-payment 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 co-payment 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 co-pay 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. BCHP will coordinate benefits with other group medical plans that cover your dependents.
To find out if you health plan is your primary or secondary source of
coverage, please read the COB section in of your Medical Plan Book or
contact Allied.
BCHP 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 a
direct claim form to the Caremark address. Your employer's office has the
forms or you may download the forms 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 a
Allied claim form to Allied. Your employer's office has the claim forms or you may download the forms from the
Forms page.
Understanding your Explanation of Benefits (EOB)
Each time you or your provider sends in a claim to Allied, a Medical or Dental EOB form will be mailed to your home. 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.
What are the most common reasons a claim may be pending?
Over ninety percent of all claims sent to Allied will be processed within 10 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 misplaced an EOB, you may visit the
Allied website to check claims status or print a duplicate
EOB.
3) Allied Customer Service is available 8:30 am to 8:00 p.m. (ET)
Monday through Thursday, Friday 9:00am to 6:00pm and Saturday 10:00am to
1:00pm except for holidays.
For faster service, have the covered employee's social security number, patient's name, and the date of service ready.
4) Call Allied to check status of a claim, do not call HealthSpan or Emerald.
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 will send you a check for 50% of the difference between the erroneous and correct amounts, up to a maximum of $1,000.
