We want to ensure that healthcare providers get paid for their services.
Claims occur directly between healthcare providers and the medical schemes. Alignd does not participate in the claims process for the healthcare services provided to patients enrolled on our Serious Illness Benefit (SIB).
However, as your partner, we will endeavour to support you where you may experience difficulties or where any part of our arrangements with our partner medical schemes is not working optimally.
Send your claim directly to the scheme
Claims for services covered by the Alignd SIB must be submitted directly to the medical scheme of the patient you are seeing. You may submit through the following avenues:
- Ensure Alignd’s unique tariff codes are available on your chosen system
- Ensure your claim submission has all necessary claim information on it such as in this example here
- Then submit the claim to the appropriate medical scheme through EDI as normal
Email an invoice of your claims to the appropriate email address if your EDI system cannot accommodate the Alignd claim requirements.
- For Medscheme administered schemes (Fedhealth and Bonitas), use the following email addresses:
Out of hospital claims: firstname.lastname@example.org In hospital claims: email@example.com Hospice claims: firstname.lastname@example.org
You can access our standard claims template here.
- If you are dealing with an Alignd patient who is not a member of one of our partner medical schemes and Alignd have obtained approval from the scheme involved, then please email email@example.com to see how we might assist with your claims.
- If you have non-oncology patients, send the referral and case details to firstname.lastname@example.org, as these need to be approved on a case by case basis by the medical scheme. If they are approved, the Alignd claims process should be followed as normal.
Include the necessary details on your claim submission
Whether you submit your claim via EDI or as a “paper claim”, you will need to ensure your claim submissions have the correct information.
When submitting please ensure you have included all the following correctly, otherwise your claim may be rejected.
- Member name and surname
- Name of medical scheme
- Membership number and dependent code
- Service date/s
- Healthcare professional’s details and BHF practice number
- NB: For nurses and social workers, the referring Alignd Network doctor’s name and practice number should also be included
- Diagnostic code (i.e. the ICD-10 code which is Z51.5 for palliative care), to be included on every claim line
Navigate the Alignd Serious Illness Benefit
We have produced a tariff guide for each of our provider groups. These include tariffs, codes, rates, applicable limits and claiming rules. Please make sure you are claiming in accordance with these guides. If you are unsure of how to claim for your consultations or would like our latest guide, please email email@example.com.
- You are claiming for the correct Alignd consultation code
- The Alignd SIB has different codes depending on whether the patient is on the Ongoing or Intensive benefit.
- There are also different codes for the initial consultations vs the follow up consultations on either benefit.
- Please see additional differences in our tariff guide below.
- You are using the correct Alignd tariff code and rate for the year of service
- The tariff code must also be appropriate for your registered provider type (e.g. you must have a registered nurse practice code to claim the registered nurse consultation code).
- You have not claimed above the standard Alignd SIB limit for a specific Alignd code (check the remittance)
- Note: Exceptions can be considered but additional claims will not be paid unless the exception has been approved and processed by Alignd. Exception applications should be made via the individual patient thread on Signapps.
- Most Alignd related benefit limits are per lifetime, which means they do not restart at the start of the year.
- You are following all other Alignd billing rules. Some common points:
- You may not bill for intensive and ongoing consultations on the same day for the same patient.
- You may not bill for intensive consultations as well as the daily global professional fee (currently only billable by Alignd Network hospices) for the same patient.
- Each claim line should have one tariff code (do not include both the RPL and Alignd tariff code, only Alignd codes).
- If the patient is in a hospital when seen then you must use the in-facility codes and rates as per the tariff guide.
- You are registered on the Alignd Network
- You must be registered as part of the Alignd Network to claim our Alignd tariff codes.
Address your claim queries
Claims payments are made by the medical scheme directly to the healthcare provider and Alignd does not participate in the claims process. However, as stated above, Alignd will endeavour to support you where you may experience difficulties or where any part of our arrangements with the medical scheme is not working optimally.
If your claim was not successfully processed, the remittance from the scheme will include a reason for the claim rejection. Please first check this reason and assess if you’re able to resolve the issue yourself.
If you are unable to resolve it, then please follow the support avenues below:
Unpaid claims, understanding rejections, resubmitting amended claims, etc are to be directed to the medical scheme administrator.
- Medscheme (Fedhealth and Bonitas): firstname.lastname@example.org
Providers must be registered on the provider network with our partner schemes before they can be successfully paid. In addition, all details must be up to date, e.g. banking details. For all such queries, contact the scheme directly:
- Medscheme (Fedhealth and Bonitas): email email@example.com
In order for any Alignd tariff codes to be successfully paid, the following must be in place:
- The claiming providers need to be registered as part of the Alignd Provider Network, and
- The patient must be enrolled on the Alignd SIB by their medical scheme at the time of service
For all Alignd Network registration support, email Alignd at firstname.lastname@example.org.
In some cases, the patient may have needs beyond our standard benefit limits and you may want to apply for an exception. Any patient specific exceptions should be requested on the individual patient thread on Signapps.
If the above processes don’t resolve your claim issues, or you are not assisted sufficiently, please email email@example.com your queries/concerns.