Eligibility Requirements for Sharing When Seeing a Medical Specialist

Introduction

Your REDEEM® HealthShare Ministry membership includes visits to specialists. You must adhere to these eligibility requirements for sharing. 

Specialist visits are subject to the Unshareable Amount and if applicable, your Co-Share.

Information

The following are eligibility criteria for seeing a specialist:

• The condition, injury, or illness must have developed after the start of your membership. 
  Important: If you are a new member, there are sharing limits for the first 90 days. This waiting period does not apply to Samaritan® Basic or Samaritan® Classic members.
• You must submit all properly coded and documented bills within 12 months of the date of specialty visit service using the online submission tool.  Bills submitted by providers must follow standard healthcare industry submission and coding guidelines to meet sharing consideration.
  Note: Many medical providers are willing to submit bills electronically via the Member Card EDI number. However, if you manually Submit a Medical Bill for processing, you must submit it using the online submission portal in the Member Center. 
• The services or items in the bill must be within the scope of licensing and ordered or provided by:
  • Medical Doctor (M.D.)
  • Doctor of Osteopathy (D.O.)
  • Naturopathic Doctor (N.D.)
  • Nurse Practitioner (N.P. or A.P.R.N.)
  • Physician Assistant (P.A.)
  • Doctor of Podiatric Medicine (D.P.M.)
  • Dentist (D.D.S or D.M.D.)
  • Midwife (if certified)
  • Ophthalmologist
  • Chiropractor

• All medical tests and treatments must take place at:
  • Hospital
  • Ambulatory center
  • Clinic
  • Doctor’s office
  • Diagnostic facility
  • Independent facility
  • Residential setting (only for home births, hospice care, and pre-approved home health).
  • Skilled nursing and Rehabilitation facility

As a member of REDEEM HealthShare, reading and understanding the Sharing Guidelines is important.