| Amount Paid |
Checknumber |
Type |
Check URL |
Release Date |
Check Date |
Check Clear Date |
Check Clear URL |
Payee |
Payment to name |
Payment to address |
Payment to city |
Payment to state |
Payment to zip |
Created by |
2022 Claim Reconciliation Audit
Welcome ,
We are unable to determine your true out-of-pocket due to the fact that either BCBS or your providers have indicated to us that you have health coverage other than BCBS.
Please click on the this link and throughly complete the section of enrollment where we asked what other outside coverage you have. We are required to inventory all other coverage before we authorize any payments from the City of Quincy HRA plan.
Coalition Health is a third-party privacy manager hired by your employer to track all Deductible Reimbursements owed to your family while privately maintaining your family's sensitive medical claim info.
Each 15th of the month, BCBS releases claims that they processed in the month prior so that we can calculate the amount of reimbursement necessary to maintain the same out of pocket benefit you enjoyed last year. Because of this slight time delay newly processed claims might take a little time to cycle through.
Always remember, you have two sources of coverage that combine to create last year's benefit:
1. BCBS and
2. Your Employer HRA (Deductible Reimbursement)
Two layers of benefit adds an extra step to settling your claims, but it produced enough savings to avert a significant increase in payroll deductions on May 1 for employees with dependents.
As your auditor, Coalition Health has tried to simplify this TWO TIERED plan into a simple thermometer display that depicts the amount of deductible/coinsurance each person in your family has accumulated (including carryover). Gray means out of pocket remaining. Green means out of pocket partially satisfied. Red means MAX OUT OF POCKET REACHED.
Our job is to identify the total amount of reimbursements due your family.
After calculating what is owed, we DOSE PAYMENTS to your providers directly. We then show the remaining balances that you should pay.
Every month you can reopen this SAME LINK to view your newest claims closeout.
Instructions:
1. Review the accumulated out of pocket displayed on the THERMOMETERS created for each of your family members.
2. Review the summary BY PROVIDER to know who you owe.
3. Click on VIEW DETAILS to see claim by claim the attribution of your responsibility AFTER HRA PAYMENTS.
4. If you have any question EMAIL HELP@CoalitionHealth.com
Plan year:
Individual Accumulated Deductible Thermometer
Legends
Auditor comment
| Name |
Relation |
Auditor Memo |
Summary By Provider
| Provider |
Total Billed |
Penalty |
Allowed Amount |
BCBS Paid |
Amount Due Provider |
HRA Paid |
HRA Credit Payment |
Patient Owes Provider |
Summary By Household Member
(In-Network Excluding QMG 100% Clinic)
| First Name |
Last Name |
Total Billed |
Penalty |
Allowed Amount |
BCBS Paid |
Amount Due Provider |
HRA Paid |
HRA Credit Payment |
Patient Owes Provider |
Summary By Household Member
(Out-of-Network Excluding QMG 100%)
| First Name |
Last Name |
Total Billed |
Penalty |
Allowed Amount |
BCBS Paid |
Amount Due Provider |
HRA Paid |
HRA Credit Payment |
Patient Owes Provider |
HRA Budget By HHID
(In-Network Excluding QMG 100%)
| HHID |
Name |
HRA Budget |
HRA Paid |
Remaining Budget |
Other Coverage |
Total HRA Budget By Empid
(In-Network Excluding QMG 100%)
| Empid |
HRA Budget |
HRA Paid |
Remaining Budget |
Other Coverage |
Detailed Break Down Per Claim
(In-Network Excluding QMG 100% Clinic)
| Processed Date |
Date of Service |
Name |
Claim Number |
Provider |
Total Billed |
Penalty |
Allowed Amount |
BCBS Paid |
Amount Due Provider |
ADJ - Deductible |
ADJ - Coinsurance |
ADJ - patientowes |
ADJ - carrierowes |
TPA HRA OWES |
HRA Paid |
HRA Credit Payment |
Patient Owes Provider |
Detailed Break Down Of QMG 100% Free Employee Clinic Claims
| Date |
First Name |
Last Name |
Claim Number |
Provider |
Total Billed |
Penalty |
Allowed Amount |
BCBS Paid |
Amount Due Provider |
HRA Paid |
Patient Owes Provider |
Detailed Break Down Of QMG claims
| Date |
First Name |
Last Name |
Claim Number |
Provider |
Total Billed |
Penalty |
Allowed Amount |
BCBS Paid |
Amount Due Provider |
HRA Paid |
Patient Owes Provider |
Detailed Break Down Of Claim Closeout Incudes The Following Claims Processed By BCBS Prior To
(Out-of-Network)
| Date |
First Name |
Last Name |
Claim Number |
Provider |
Total Billed |
Penalty |
Allowed Amount |
BCBS Paid |
Amount Due Provider |
HRA Paid |
Patient Owes Provider |
Detailed Break Down Of BCBS Originally denied claims FYI
| Date |
First Name |
Last Name |
Claim Number |
Provider |
Total Billed |
Penalty |
Allowed Amount |
BCBS Paid |
Amount Due Provider |
HRA Paid |
Patient Owes Provider |
Detailed Break Down Of Claims Detected As New By The VIP Puller And Will Be Closed Out After BCBS Finalizes
| Date |
First Name |
Last Name |
Claim Number |
Provider |
Total Billed |