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Medical Claims

This claims module will allow Partners to enter their medical claims fully electronically. It will eliminate duplicate or additional work for the Partners, claims administrator (Aon) and AFS International, thus making the whole process more effective for all parties concerned. Keeping track of claims' status and reimbursements will also be easier. 

AFS-USA's medical claims administration process is not being affected by this. This module is currently to be used only for claims incurred outside the U.S.  Each Partner should appoint one or more staff members who will have access to the Module in their office.

Status

Description

Preparing

In process of entering data into claim form

Returned

Claim sent back by AON for incomplete information

Submitted

Partner completes data for claim and sends for approval as non-Supplemental claim

Approved

AON approves claim

Invoiced

AFS Int’l invoices for payment to Partner, either for next partner payment or directly

Paid

Payment is complete to partner

Rejected

Claim is rejected by AON

Supplemental

Partner completes data for Supplemental claim and sends for approval

ACE

View ACE claims

All

View all claims


To enter a new claim, click on New Claim to begin entering the information. Your IOC Partner code should be the default but please verify this first.

Once you are in the medical claim form itself, the process is self-explanatory. Input all the required fields, as appropriate. It is still necessary to send payment receipts with the medical claims.  These receipts may be scanned and attached to each claim electronically as .pdf files, or they may be mailed separately to Aon. Mailing them will delay the approval process and is not recommended, unless you are submitting large quantities of medical claims at one time.  Be sure to select the appropriate category and sub-category of claim from the drop-down menus.

As per the medical records retention policy, original receipts should be kept by the Partner for five years plus the current year in case there are any insurance issues that need to be investigated. Original receipts for claims exceeding USD 5,000 should always be mailed to Aon so the claim can be filed with the insurance company.

Claims may be saved until they are ready to be submitted. Once a claim is "Submitted", it cannot be recalled. Please advise me of any mistakes for correction. I will delete the claim so it can be re-entered.  Aon will review the claims and approve or reject them. Partners will be advised of any rejections and may also log in to see the status of all claims they have submitted.

Claims over USD 5,000, JPN and NOR participants claims:

Please note that for all claims that are over USD 5,000 and all for claims that are from JPN and NOR participants, the original receipts must be sent to Aon. You may scan and attach these receipts as you normally would in filling out the electronic claim form but the original receipts are needed by Aon in order for them to submit the claims for reimbursement from insurance companies.

Reimbursements The default for reimbursements will be through the Finance Module. With quarterly clearings, we would expect that most Partners would choose this method. The exchange rate to be used will be the rate to the actual clearing date.  If a Partner prefers direct reimbursement in their local currency, then the "Pay outside FM" button must be selected.  AFS International will originate the local currency reimbursements on a monthly basis. Special arrangements can be made if this will cause any cash flow issues due to any specific large claim. 

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