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 PHCS network. Your provider should recognize the PHCS 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 the back of 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 (also found on the back of your card) 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 will not submit your bill directly to Medi-Share, please direct them to call our Provider line at (321) 308-7777.
    • If an in-network provider still refuses to bill Medi-Share directly after talking to our hotline, you may want to consult the PHCS network to search and locate another provider.
    • 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 Member Reimbursement form directly to Medi-Share. This process typically takes up to 30 days.
  3. What is a HCFA or UB?
    • HCFA and UB are industry-standard healthcare forms that all providers utilize to submit medical services for payment.
    • 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, these forms provide everything Medi-Share may need 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 by utilizing out-of-network providers, you may incur an additional member responsibility.
      • 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 and may be approved upon 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 reimbursement.
  5. Final Notes
    • Please familiarize yourself with the program guidelines. The following are not eligible for sharing and should not be submitted for reimbursement:
      • 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 should not be submitted to Medi-Share:
      • The notification that you paid AHP
      • Payment of your provider fees
      • Payment of other charges noted as your responsibility

Member FAQs

+ What if my reimbursement is missing information?

After submitting a partial reimbursement, you may receive an Explanation of Sharing (EOS) requesting additional/missing information. In order to ensure a faster re-processing of your reimbursement request, you must attach the missing information with the EOS. Failure to include the EOS will result in a delay of at least 160 additional business days.

+ 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.

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

Although it might seem there is a savings to Medi-Share or the member, pre-payment can negatively alter bill processing and add more effort on you, as the member.
Medi-Share will still process eligible bills with the contracted rate for PHCS 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 chart in the service 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.