Over the Wire: Spring 2018

Have an outstanding claim?

EBFA working towards improving claims processing timeliness

It’s a busy time of year for EBFA’s claims department. Traditionally, the Fund Office sees higher claim volumes from October to March. That’s because the Plan provides maximum amounts of coverage on a calendar year basis. So, many Plan Members try to use up their health benefits in the latter months and submit those claims to the Fund Office before the end of the calendar year. The increased volume is carried over to the start of the following calendar year. Claim volumes also increased in the first quarter of the calendar year as Plan Members take advantage of the new maximums for the new year.

There are also a couple of things Plan Members can do to help with claims processing:

Submit Sooner

A Plan Member can submit claims immediately to the Fund Office after an expense is incurred rather than waiting until the end of the calendar year.

Provide Complete Paperwork

Claims processing may be delayed due to incomplete paperwork. Delay can be avoided if Plan Members have filled out all the required information on the correct direct reimbursement forms before submitting claims to the Fund Office, including signing and dating the form, attaching receipts and/or invoices, as well as including referral paperwork, if applicable. Whenever possible, EBFA claims staff will contact Plan Members and service providers to get more information and documentation necessary to complete the claim. As a last resort, the Fund Office may need to send the paperwork back to the Plan Member to obtain the required information.

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