Tips to Avoid ICHRA Claim Denials and Maximize Your Benefits
The main aim of The Individual Coverage Health Reimbursement Arrangement (ICHRA) is to offer employers and employees flexibility and cost control. If you’re lucky, this is done for you right away, however, claim denials can impair these benefits. For a better reimbursement experience, you need to address your potential issues proactively. The first step to this is to understand why an ICHRA claim can be denied.
Why Was Your Claim Denied?
There can be many reasons behind the denial of your claim, some of these are:
- Your Insurance Plan does not meet the Affordable Care Act (ACA) requirements.
- Lack of sufficient proof of coverage or receipts.
- Submission of claims that are not included in your coverage.
- Late or Incorrect Submissions
Employer Strategies to Avoid ICHRA Claim Denials
As an employer, using the right strategy can save you a lot of money and time. The right strategy is a mix of the following:
1. Clear Communication
Employers must ensure that clear and detailed guidelines are provided for ICHRA claims. It is also crucial to communicate all important deadlines to your employees as well. This way, you ensure that your employees understand how to avoid mistakes that can lead to a claim denial.
2. Support System:
It is crucial for employers to establish an accessible support system for their employees so that they are able to ask any claim-related questions that may arise at any point in time.
3. Training Programs:
If you want your employees to stay informed regarding plan requirements, and eligible expenses, or just have regular updates to the ICHRA policy – you may want to conduct regular training sessions to keep the team informed.
Employee Practices
The employees need to be familiarized with a few practices themselves as well so that they can act right, at the right time. This includes:
1. Understand Your Plan, Take Help If Needed:
If you are an employee yourself, you must understand your ICHRA plan, including the eligible expenses and compliance requirements. This way, you can avoid submitting ineligible claims.
2. ACA-Compliant Insurance:
When choosing your insurance, ensure that you are choosing the insurance plan that meets ICHRA’s ACA compliance criteria.
3. Keep Track of Everything:
Paperwork is everything. Ensure that you are maintaining all your records in an organized manner. This includes your receipts and proof of premium payments. This will help you support your claims and prevent denials due to a lack of documentation.
4. Accurate & On Time:
Before making a submission, double-check to ensure that your submission is accurate – moreover, ensure that you meet deadlines. This will help you avoid rejections.
Reducing claim denials is no less than teamwork, which is why, it is suggested that both, employers and employees work together. The hack is simple, use clear communication between the team and protect the paperwork, and if you stick to the rules of the plan – you can maximize your benefits and experience true efficiency.
If you’re looking for an Insurance expert who could help you out and maximize efficiency for you, feel free to get in touch. – We are here to Protect You Better!
For expert advice, contact Shayne Bevilacqua at Professional Liability Insurance Group.
Call or Text us at +1 (877) PLIG – 123, That’s (877) 754 – 4123.
