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Bill Submission Process

Medi-Share is the largest and most well-known bill-sharing ministry in the country, but some providers may not be familiar with how bill sharing works. Here are some tips on how to interact with providers and their office staff when explaining Medi-Share:

  1. Present your member card to your provider
    • Let your provider know Medi-Share participates in the network listed at the top of your card. Your provider should recognize the logo on the front of your card, even if they are not familiar with Medi-Share.
    • Bills should be submitted by your provider to Medi-Share in one of two ways:
      • Electronic submissions - Utilize the EDI number on your Member ID card, or
      • Paper submission - Mail a HCFA or UB form to the Texas address also located on the back of your Member card
    • The following services require pre-notification from the provider:
      • Inpatient hospitalizations
      • Non-emergency surgeries
      • Elective cardiac procedures
      • Cancer diagnosis or treatment (including medication)
      • Organ/tissue transplants
      • Specialty medication – including in-home or office infusions and injections
  2. Providers who do not bill Medi-Share directly
    • If an in-network provider refuses to bill Medi-Share directly after talking to our representatives, you may want to search and locate another provider using the Healthcare Bluebook tool in your Member Center.
    • If you choose to continue utilizing this provider, please ensure that the provider will give you a HCFA or UB form at the time of payment. Please submit this form with proof of payment and a Medical Bill Submission Form (found in your Member Center under resources/forms) directly to Medi-Share. This process typically takes up to 45-60 days.
      • When using providers who will not bill Medi-Share directly, it is important to obtain a HCFA or UB prior to payment. A HCFA or UB submission is the fastest and easiest method for Medi-Share to process your submission.
  3. What is a HCFA or UB?
    • HCFA and UB are industry-standard healthcare forms that all providers utilize to submit medical services for consideration.
    • Besides being industry-standard, these forms are important for efficient and accurate processing of medical needs according to our member-voted guidelines.
    • In most cases, properly completed forms provide Medi-Share what’s needed for initial processing. Additional information like medical records, primary payer information, or supporting documentation may be requested in some situations.
  4. Out-of-Network Providers
    • Please note that when using out-of-network providers, you may incur an additional member responsibility if the Provider does not accept the Medicare allowable rate.
      • Alternatively, if the provider is a hospital or surgery center, you will be responsible for 20% of the billed charges in addition to other member responsibilities.
      • If the provider is not a hospital or surgery center, there will be an out-of-network pricing adjustment based on usual and customary rates for the area applied to the bill. If the provider rejects the pricing adjustments, they will become your responsibility to settle with the provider.
      • *** If the visit is for a life-threatening medical emergency or there are no in-network providers within 25 miles of your home, a penalty waiver request may be submitted for review  by Medi-Share.
    • When utilizing out-of-network providers who refuse to bill Medi-Share directly, it is important to obtain a HCFA or UB prior to payment. A HCFA or UB submission is the fastest and easiest method for Medi-Share to process your submission.
  5. Final Notes
    • Please familiarize yourself with the program guidelines. The following examples are not eligible for sharing and should not be submitted for consideration:
      • Chiropractic care that has not been previously approved in-lieu of surgery
      • Routine/preventative services outside of well-child visits up to the age of 6
      • Annual physicals with limited labs for Medi-Share Members on a new program level as of 7/1/20
      • Dental services not related to an accident
      • Mental health counseling and psychiatric services not related to an eligible medical event
    • In addition, the following are not necessary to support your request:
      • A notification that you met your AHP
      • Proof of your provider fee payment(s)
      • Proof of other charges noted as your responsibility
      • Submission of ineligible bill

Member FAQs

+ How do I ask my provider for a HCFA or UB?

Prior to making a payment, talk to the business/billing office or office manager to ask for a HCFA or UB form. Requesting a HCFA or UB form prior to payment is vital to be able to obtain the form. Only request a form if the provider will not bill Medi-Share directly. Having the provider submit will decrease the processing timeframe.

+ What if the provider treats me as “uninsured” and offers me self-pay or a cash pay discounted rate?

If your provider identifies you as “uninsured” or “self/cash pay,” it will be more difficult to obtain a HCFA or UB as these are typically used to submit bills. Without these forms, your request/bill cannot be processed, so ask your provider to not categorize you this way and provide you with a HCFA or UB before committing to self-pay.  
Pre-paying may appear to save money for Medi-Share or the member, but it can complicate bill processing and increase the member's workload.
Medi-Share will process eligible bills with the contracted rate for in-network providers. The self-pay or cash pay rate you agreed to with the provider may not match that contracted rate.
Medi-Share will process eligible out-of-network bills allowing up to what is customary for the service in the area. It is possible that this is less than the self-pay rate. The difference between the two would be patient responsibility if the provider will not write it off.