Claims

Claims actions

• Find a Claim

• See Raw Data

• Download an EOB

• Care Events

• Cases: Creating, Assigning, and Monitoring

Prior to care

• Benefits lookup on plans

• Prior authorizations: what to know

• Medical vs. Pharmacy Benefits

• Rx Buy List

• Emergency Care Abroad

How benefits are applied

• How Claims Are Assigned Benefit Categories

• Preventive vs. Medical/Diagnostic Claims

• Pregnancy: Preventive or Not?

• Understanding ACA

Cost sharing and accumulators

• Out of Pocket Costs

• Embedded vs. Aggregate Deductibles

• Uploading Accumulators

Pricing

• Network Status & Repricing

• RBP Pricing & Balance Bills

Other coverage

• Accident Details

• Coordination of Benefits (COB)

• Medicare Primary vs. Group Health Plan (GHP)

Denials, appeals, and corrections

• Experimental / Investigational & Medical Necessity Denials

• Appeals

• Duplicate, Corrected, and Late Claims (Timely Filing)

Payment

1. Claim payment timelines

2. Stop Loss Filings Navigation