Eligible bills must meet the following criteria:
Condition, Injury, or Illness:
The bill must be for a condition, injury, or illness that developed after the start of the membership.
Only new bills for non-pre-existing conditions with Dates of Service (DoS) after the membership start date are eligible for sharing.
Bills not related to a condition, injury, or Illness such as preventive and routine wellness visits are only shareable in REDEEM Enhanced per the guidelines that govern such medical costs (reference section such and such)
A. Incurred Services or Qualifying Estimates:
In most instances the bill must be for actual services incurred. However, for maternity or in cases where significant savings can be achieved, the submission of bill estimates are acceptable.
Not Listed as Non-Eligible:
The bill must not be included in the "not eligible for sharing" category.
Submission Timeframe:
The bill must be submitted within 12 months of the Date of Service (DoS).
Most medical providers are willing to submit their bills electronically directly via the membership card’s EDI number. However, in the event that a member must submit a bill for processing and/or reimbursement, it must be submitted using the online submission tool. Bills submitted by the provider must follow standard healthcare industry submission and coding guidelines. This is necessary for bills to be considered for sharing.
-
When submitting a medical bill for processing, the member is responsible for obtaining all information needed for processing per the form available online.