Medical Bill
Submission
Process

Medical Bill
Submission
Process

Some providers may not be familiar with how bill sharing works. Here are some tips on how to interact with providers and their office staff when explaining Medi-Share: 

Provider Submission (Preferred Process): Present your member card to your provider and request they submit your bill directly to Medi-Share.

Let your provider know Medi-Share participates in the network listed at the top of your card. Your provider should recognize the logo on the front of your card, even if they are not familiar with Medi-Share.

Medi-Share member card Navitus
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Bills should be submitted by your provider to Medi-Share in one of two ways:

  • Electronic submissions - Utilize the EDI number on your Member ID card, or
  • Log into the Medi-Share provider portal at availity.com  
  • Paper submission - Mail a HCFA or UB form to the address also located on the back of your Member card

The following services require pre-notification from the provider:

  • Inpatient hospitalizations 
  • Non-emergency surgeries
  • Elective cardiac procedures
  • Cancer diagnosis or treatment (including medication)
  • Organ/tissue transplants
  • Speciality medication - including in-home or office infusions and injections
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Providers who do not bill Medi-Share directly
If an in-network provider refuses to bill Medi-Share directly after talking to our representatives, you may want to search and locate another provider using the Healthcare Bluebook tool in your Member Center. 
  • If you choose to continue utilizing this provider, please ensure that the provider will give you a HCFA or UB form at the time of service. 
  • Log in to your Medi-Share Member Center.
  • Navigate to the Resources menu and select Member Forms.
  • Locate the online Medical Bill Submission Form.
  • Follow the prompts to upload your completed HCFA or UB form and include a copy of the itemized bill.
  •  Once you submit your HCFA or UB form, you’ll receive a confirmation email with case number for your reference. Once processing has been completed, you’ll receive an email directing you to review your EOS available in the Member Center.  
  • If payment is due, you will receive the check as reflected on your EOS and are responsible for paying your provider.
Providers who do not bill Medi-Share 65+ directly

If a provider refuses to bill Medi-Share directly after talking to our representatives, ensure you follow these steps to manually submit your bills. 

  1. Log in to your Medi-Share Member Center.
  2. Navigate to the Resources menu and select Member Forms.
  3. Locate the online Medical Bill Submission Form (65+).
  4. Upload your Medicare Summary Notice (MSN).
    • Medicare Claims for Part A of the Medicare Medical Summary Notice (MSN)
    • Medicare Claims Part B of the Medicare Medical Summary Notice (MSN)
    • Please only submit the page stating “Claims for Part A” or “Claims for Part B” of the Medicare Medical Summary
  5. Spouses and dependents that are not Medi-Share 65+ should use the “Medical Bill Submission Form” 
What is a HCFA or UB?
HCFA and UB are industry-standard healthcare forms that all providers utilize to submit medical services for consideration. 
  • Besides being industry-standard, these forms are important for efficient and accurate processing of medical needs according to our member-voted guidelines. 
  • In most cases, properly completed forms provide Medi-Share what’s needed for initial processing. Additional information like medical records, primary payer information, or supporting documentation may be requested in some situations. 
  • What if my provider won’t give me a HCFA or UB form? You can still submit your bill here, however, without the HCFA or UB details, more information from you will be required and it will take more time to process your request. 
Out-of-Network Providers 
Please note that when using out-of-network providers, you may incur an additional member responsibility if the Provider does not accept the Medicare allowable rate. Please review the Medi-Share Guidelines, Section V. B. 
  • *** If the visit is for a life-threatening medical emergency or there are no in-network providers within 25 miles of your home, a penalty waiver request may be submitted for review  by Medi-Share. 
  • When utilizing out-of-network providers who refuse to bill Medi-Share directly, it is important to obtain a HCFA or UB at the time of service. Submit your HCFA or UB here. (link) Once received, you’ll receive a confirmation email with case number for your reference. Once processing has been completed, you’ll receive an email directing you to review your EOS available in the Member Center. 
  • If payment is due, you will receive the check as reflected on your EOS and are responsible for paying your provider. 
Additional Detail

The Submission process must be completed using this online link. Please do not email your request, or use any other paper form to submit any medical bill or any supporting documentation.  

The following are not necessary to support your request: 

    • A notification that you met your AHP 
    • Proof of your provider fee payment(s) 
    • Proof of other charges noted as your responsibility 
    • Submission of ineligible bill 

Please familiarize yourself with the program guidelines. The following examples are not eligible for sharing and should never be submitted for consideration: 

    • Chiropractic care that has not been previously approved in-lieu of surgery 
    • Routine/preventative services outside of well-child visits up to the age of 6 
    • Annual physicals with limited labs for Medi-Share Members on a new program level as of 7/1/20 
    • Dental services not related to an accident
    • Mental health counseling and psychiatric services not related to an eligible medical event