1. What kind of company is Med-Pay, Inc.? Is it an insurance company? 
Med-Pay is a Third Party Administration (TPA) firm. This means that Med-Pay provides claims administration services for companies with self-funded (versus insured) group medical, dental, and/or vision plans.

Med-Pay is not an insurance company; nor are we owned by any insurance company.

2. Where is Med-Pay? How long has Med-Pay been in business? 
Located in Springfield, Missouri, Med-Pay was founded in early 80s, and has become a specialty company for client-employers looking for customized health care administration programs. We administer claims programs for employers with associates located all over the United States.

As an associate covered under a Med-Pay administered plan, a dedicated claims unit handles your healthcare claims. Whenever you have a question about a claim, please feel free to call our customer service department and talk it over.

3. Will I have a health plan identification card? 
Yes. This card is important to you and your family because you will be able to use it whenever you need medical care.

You'll notice that your ID card has several unique features. First it identifies you by name and a unique identification number. Second, it indicates if you have a spouse or family covered by the plan. It also advises of any precertification requirements, provides billing information, and any applicable co-pays. And, last but not least, it contains your company's name.

4. How many cards will I receive? 
Med-Pay automatically generates two ID cards on one printout. If you have family coverage, one of the two cards should be given to your spouse. Otherwise, you can dispose of the extra copy or keep it as a spare.  (Keeping it in a secure place, of course.) If you need an additional card for a dependent who lives away from home (for example, a college student) or for a dependent child who does not live with you, contact us.

5. What if I add or drop dependents and need a new card? 
If your family status changes due to marriage, birth, divorce or for any other reason, the change should be reported to your human resource office immediately. Your enrollment information can then be changed; and, if a new card is required, it will be automatically produced.

6. What if I lose my I.D. card? 
A lost I.D. card should be reported immediately. Contact Med-Pay and a new card will be issued.

7. Where can I get claim forms? 
Claim forms are available from Med-Pay or your personnel/human resources departments. You can also access a claim form on our website at www.med-pay.com.

Note that you don’t need a claim form each time a medical claim is filed with Med-Pay. Just ask your healthcare provider to submit an itemized bill directly to us. We then utilize the information provided to process your claim. Whenever a claim is submitted, we always send you an Explanation Of Benefits (EOB) which outlines how the claim was processed.

8. What if my healthcare provider won't accept my Med-Pay identification card? 
If your healthcare provider refuses to bill Med-Pay directly, you may have to pay the bill and then send it to us. Be sure that the bill is either noted as having been paid or include a payment receipt with your claim submission. Otherwise, if you do not include some indication that you have paid the bill yourself, we may issue payment directly to the provider. Also, be sure that you send us the original bill, keeping a copy for your records.

If you wish, we will contact your doctor on your behalf to explain our direct billing system. Feel free to contact our customer service department to discuss.

9. How quickly can I expect claims payment? 
Med-Pay processes clean claims within ten business days after they are received.

10. What is a "clean" claim? 
A clean claim includes all of the information we need to process your claim. This information includes (but is not limited to):  Employee’s Name and Identification Number, Patient's Name,
Date of Service, Diagnosis, Type of Service, Charge for Sservice Rendered.

11. If MED-PAY has the information, will the bill be paid? 
Having an itemized bill allows Med-Pay to begin claims processing. There are many other factors that Med-Pay will look at before a bill is processed and/or if any payment is due. Among the questions that a claims adjudicator reviews when processing a claim:

• • Is there any other group coverage? If so, we’ll need information to determine primary versus secondary coverage (i.e., who pays first).
  • Was the claim related to an accident? If so, an incident questionnaire form will have to be completed and returned advising how, when and where the accident occurred. 
  • Are the charges reasonable and customary for the services provided? Generally, this is an issue only if you go outside your preferred provider network. 
• • Are the charges covered under the provisions of your group’s healthcare plan? Remember, just because the doctor orders it doesn’t necessarily mean it’s a covered expense under your healthcare plan.

12. What does Med-Pay do when it doesn’t have enough information to process my claim? 
When a claim is incomplete, a request for additional information is sent to you and/or the provider, as necessary. If the request is made to the provider, a copy of the request is always sent to you. Note that if a response is not received from either you or the provider in a timely manner, your claim may be denied.

13. What is "timely filing"?
Every health plan has a maximum amount of time from when your claim is incurred to be considered under the plan. If it’s not received within that timeframe, it will be denied. Therefore, please be sure to keep track of all of your claims and review all Explanations Of Benefits (EOBs to assure that the claim has, in fact, been submitted to us.)

14. Is there anything I can do to help get my claim processed? 
By assuring that an itemized (clean claim) is provided, you help us to get your claims processed quickly and efficiently.

Other things you can do to help:

     Unless there’s coordination of benefits with another group plan, be sure to send the original bill if you are submitting it. Med-Pay cannot accept a photocopy for primary payment. 

     If there is other coverage, inform Med-Pay of that coverage information. If the other plan must pay the bill first, send us a copy of the bill and the Explanation of Benefits form from the other company. Note, Med-Pay sends out an inquiry form regarding other insurance. Please be sure to complete it in its entirety and return at your earliest convenience to avoid any delay in processing of claims.

     If you've paid a bill, make sure it is marked paid or send a receipt with the bill. (Any payment due is issued to the provider of services if the bill does not indicate that payment has already been made).

     If the service was due to an accidental injury, be sure to tell Med-Pay how, when and where the accident happened. In this case, completing a claim form or an accident/incident form may be necessary.

15. What do I do if I do not agree with the way my claim was processed? 
Should you disagree with the claim result, you may appeal the determination. Your claim appeal must be made in writing and must be made within a specified time frame that’s outlined in your plan document. Your appeal letter should specifically state why you think the claim decision is not correct. If you have additional information that you think is important to your claim, you should include it with your appeal letter.

Your appeal will be reviewed by our appeals determination specialist who reviews the claim, including incorporating other departmental and/or management resources, as necessary and appropriate. This specialist will have not made the original determination. If the appeal specialist determines that you are right, your claim will be sent to the adjudicator for re-processing. If the specialist determines that the claim was processed correctly, you will receive a letter with an explanation. If, upon receipt of that appeal determination, you decide to appeal the claim further, that subsequent appeal should be directed to your company's administrative department as outlined in your plan document.

16 Does Med-Pay have a toll-free telephone number?  
Yes, you can call Med-Pay via our toll-free number. It is: 1(800) 777-9087. This number is also on your ID card.

17. How else can I contact MED-PAY? 
In addition to the toll-free number, you can also call Med-Pay at: (417) 886-6886. For your convenience, you can makes inquiries via our website at www.med-pay.com. You can contact us any time you have questions about the plan, the status of a bill, or a question about payment.

You can also write to Med-Pay at: PO Box 10909, Springfield, Missouri 68508.

We look forward to working with you.       
   The Med-Pay Staff

MED-PAY, INC. 
Springfield, Missouri
800.777.9087
417.886.6886