Medi-Share FAQs

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Medi-Share Value FAQs

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Submitting Bills

Do all medical bills count toward your Initial Member Responsibility (IMR) or toward sharing?

  • Only Eligible medical bills count toward your IMR for sharing. Please reference the Medi-Share Value Guidelines section VI. Details of Sharing.

How do I submit my medical bills?

  • Login to the Member Center and click Submit Medical Bill.
    • Eligible medical bills may be submitted for sharing when the medical expense exceeds the IMR ($500 or $1000) per day or per stay.
    • Bills submitted after 6 months from the date of service or discharge will not be eligible for sharing.
    • To ensure eligible medical bills are considered for sharing, Medi-Share

      Value members:
      1. Login to the Member Center to use Healthcare Bluebook* to find a provider or procedure before seeking care.
      2. Complete the Notification process when indicated by Healthcare Bluebook*.
        • The search results will indicate if it is necessary to notify the Navigation Team. If not, the Member will:
        • Request a self-pay price with the provider at time of visit.
      3. Agree on payment with the provider.
      4. Submit bills that exceed the IMR per day or per stay using the Bill Submission process located in the member center as soon as possible.
  • In the event of a medical emergency, you should seek care from the nearest hospital or doctor. Members should pay the minimum amount at the time of service, and ask to set up a payment plan. It is important to notify the Navigation Team after receiving emergency care so they can assist you if additional medical care is needed, or to help settle your medical bill with the provider.
  • For additional information about the Navigation Team please refer to the Navigation Team FAQ section.

What billing details are required for bill submission and processing?

  • Itemized bills are required for bill submission, and should include the following:
    1. Service dates
    2. An itemized list of charges. If the procedure code (CPT/HCPCS code) or Diagnosis/ICD 10 code is not available, please include medical records from the date of service.
    3. Charged, Discounted, and Paid amounts
    4. Provider Contact details, including: name, address, phone number, TIN or NPI.
  • Please see the bill submission form located in the member center.

How do I submit prescriptions?

  • Prescriptions are submitted using a Prescription Reimbursement Form.
  • Please follow the instructions on the Prescription Reimbursement Form located in the Member Center. At the top of the Member Center homepage, navigate to Resources > Forms
  • Prescription sharing is subject to Medi-Share Value Guidelines section VI.I. Medical Conditions and Services Subject to Limited Sharing
  • Prescription medications, including maintenance medications, are eligible for sharing for six months per each new condition that is not pre-existing. This includes prescription drugs that may be dispensed, infused, injected, or administered by a Medical Doctor (M.D.), Doctor of Osteopathy (D.O.), Nurse Practitioner (N.P.), Physician Assistant (P.A.), or Doctor of Podiatric Medicine (D.P.M.). A new medication for an existing condition does not restart the six-month timeline. Exceptions may be made in the case of medications for cancer and transplant recipients. Requirements for exception consideration include application to a Patient Assistance Program (PAP) and other available programs for medication cost when available. Use of Medi-Share Value preferred specialty pharmacy formulary and providers are required when applicable.
  • Specialty medications (including infusions/injections given at home or in a doctor’s office) require pre-notification to Navitus, call 833-837-4307. You can also call with prescription questions or visit memberportal.navitus.com to search pricing at local pharmacies.

How do I submit an Emergency Care bill?

  • In the event of a medical emergency, you should seek care from the nearest hospital or doctor. Members should pay the minimum amount at the time of service, and ask to set up a payment plan. It is important to notify the Navigation Team after receiving emergency care so they can assist you if additional medical care is needed, or to help settle your medical bill with the provider.
  • It is important to remember that submitted bills will only be reviewed for reimbursement once you have met the IMR ($500 or $1000) per day or stay.
  • To submit bills, login to the Member Center and click Submit Medical Bill.

What is an Initial Member Responsibility (IMR)?

  • The IMR is the dollar amount, either "per day" or "per stay," that is each member's responsibility before Eligible Medical Bills may be submitted for sharing. The IMR will apply one time per day for all medical services occurring on that day, or one time per stay for all medical services occurring during an inpatient treatment/procedure that spans multiple days without discharge.
    1. PER DAY: For medical services not occurring during an admission to a facility, the IMR will apply one time per day (based on date of service), including but not limited to:
      1. Office visit
      2. Urgent Care visit
      3. Prescriptions filled same day
      4. Single Day Emergency Room visit
      5. Emergency Transport
      6. Laboratory Services
      7. Radiology Services
      8. Outpatient Physical, Speech, or Occupational Therapy
      9. Outpatient/Office Infusion
      10. Home Health Care
      11. Telehealth Visit (beyond included with membership)
    2. PER STAY: For medical services occurring during an inpatient treatment or procedure that spans multiple days without discharge including but not limited to:
      1. Facility/Hospital/Surgical Center Charges* (in-patient or out patient)
      2. Physician and provider services during admission
      3. Ancillary bills (facility charges other than room and board, such as x-rays, medication, laboratory services, etc.)
      4. Anesthesia Charges
      5. Pathology Services
      6. Diagnostic Consultations/Interpretation
    3. Maternity IMR: There is an additional Maternity $3,000 that is applied per maternity event.
      1. When using global billing, the IMR is considered “per stay” and the IMR and Maternity IMR are applied to the collective maternity care global bill. The Member should request global billing from the provider to avoid unnecessary “per day” IMRs.

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