For Providers:
Medi-Share Complete

Medi-Share Complete Guidelines 

Determining Eligibility

The member-voted Guidelines explain the program requirements and how Christian Care Ministry facilitates medical bill sharing.

• The eligibility of a medical bill for sharing is determined after medical services are rendered.
• Some care requires pre-notification (see below and the Medi-Share Guidelines Section III. E.)
• Medical and lifestyle information help determine eligibility. Medical records from 36 months prior to membership may also be needed. The need for medical records is determined by the nature of the illness or the circumstances of the injury. If access to requested medical records is refused, the medical bill(s) cannot be shared.
• Some treatments, medical conditions, procedures, and services are subject to limited sharing, included but not limited to*:
  • Pre-existing conditions
  • First month of membership
  • Prescriptions
  • Physical therapy
• Some treatments, medical conditions, procedures, and services are ineligible for sharing according to our member-voted guidelines, included but not limited to*:
  • Abortion
  • Alcohol and drug related injuries/illnesses
  • Intentionally self-inflicted injuries

* These lists are not exhaustive. For complete details of sharing limitations, see Section VI. I & J of the member-voted guidelines.

How bills are processed and shared

Medi-Share members are instructed to present their Member ID cards at the time of their appointment(s) and pay their provider fee ($35 for office and hospital visits, $200 for emergency room visits).

Providers submit bills directly to Medi-Share electronically through the provider portal, or their own clearinghouse, using the information on the back of the Member ID card.

Medi-Share:

1. Processes the bill(s) to determine eligibility for sharing based on the member guidelines
2. Determines if any network discounts are applicable
3. Determines if the member’s Annual Household Portion (similar to a deductible) has been met
   • The AHP is the dollar amount a Member Household agrees to pay toward Eligible Medical Bills before any eligible bills may be shared among the Members. Even if the AHP is not yet met, providers should still submit all medical bills to Medi-Share for processing. This ensures all Eligible Medical Bills will be applied toward the AHP and allows for the possibility of discounts.
4. Providers receive an Explanation of Sharing (similar to an EOB)

Pre-notification requirements

Members are required to direct their providers to pre-notify Medi-Share for any of the following treatments to be eligible for sharing:

• Inpatient hospitalizations
• Non-emergency surgeries
• Elective procedures (i.e., cardiac)
• Cancer diagnosis or treatment (including medication)
• Organ/tissue transplant services
• Specialty medications (including infusions/injections given at home or in a doctor's office)

Please note that pre-notification does not guarantee sharing or eligibility. To pre-notify Medi-Share of a treatment or procedure as outlined above:

Option 1. (Fastest path): Click the blue Availity Portal button below to log in, then go to the 'Resources' tab in the portal to submit the Availity / Medi-Share Pre-Notification Form.

Availity Login

• If you do not already have an Availity Account, we encourage you to register now for a smoother experience: www.availity.com 

Option 2. Call (800) 264-2562 to speak to a Customer Service Advocate. Note: you may experience long wait times.

Option 3. If you are unable to use Availity or call, complete and return this
Pre-Notification Form via fax to (321) 722-5135. Note: processing will take longer using this method. Also, forms without complete information or attached documentation will not be processed.