Frequently Asked Questions
What are the primary financial benefits for my practice?
Your practice receives the full allowed amount through a single payment including the plan and patient portion of a claim. PayMedix can reduce bad debt write-offs and the operational costs tied to patient collections and managing payment plans in-house including but not limited to credit card processing fees, banking fees, mailing and postage, administrative time.
How does PayMedix change my collection process?
You no longer need to collect copays or deductibles from patients at the point of service. PayMedix pays the full allowed amount, including the patient portion, after the claim is adjudicated. This removes the uncertainty and administrative effort associated with collecting patient balances.
How and when do I get paid?
After the claim is adjudicated, PayMedix sends a single ACH payment covering both the employer/plan portion and the patient portion for covered, in-network services. Instead of waiting for multiple payments from different sources, you receive the full allowed amount in one transaction.
Does this require a change to my current medical billing workflow?
No changes to current billing workflow are required. You continue submitting claims to the address listed on the patient’s ID card, just as you do today. The difference is that once the claim is processed, you receive the full payment from a single source instead of
managing separate payments from the plan and the patient.
How are service fees handled?
To keep the process simple, a service fee is deducted from each claim when payment is remitted. Many providers find that the fee is offset by patient continuity of care, the elimination of patient collection costs, bad debt write-offs, and the administrative effort associated with billing patients.
How do I identify a PayMedix member?
PayMedix members are identified by a PayMedix logo on their insurance ID card. Membership can also be confirmed during a standard benefits and eligibility check through the Third Party Administrator (TPA).
What kinds of patients can I expect to see under PayMedix?
PayMedix works with commercial health plan members sponsored by employers. It does not apply to workers’ compensation or auto insurance claims.
What happens if a patient is out-of-network?
PayMedix pays the patient portion only for in-network services. If a patient receives care outside of a participating network, claims should still be submitted as usual, but PayMedix will only cover the patient share when the services are in-network.
What happens if the patient doesn’t repay PayMedix?
Providers are still paid in full. PayMedix assumes responsibility for patient repayment after the claim is adjudicated, so your practice does not carry patient collection risk.
What service is PayMedix providing?
PayMedix is solving the problem of high out-of-pockets costs by guaranteeing credit for all employees, payments for all providers, and simplicity for everyone.
How much experience does PayMedix have in the market?
For 12 years, PayMedix has been the payment platform for HPS (Health Payment Systems), which has a PPO network of 96 hospitals and 27,000 individual providers. PayMedix has processed over $5 billion in medical payments and now we’re making the advantages of PayMedix available nationwide, wherever you have employees.
How does PayMedix help employees?
PayMedix is an added health benefit for your employees because:
- PayMedix automatically enrolls all employees and guarantees them credit up to their OOP maximums, regardless of individual credit histories
- With financial security and the option to pay over time, your employees are less stressed and less likely to put off important medical care
How much interest does PayMedix charge?
PayMedix offers flexible low- or no-interest payment options and can work with those employees who have additional need.
How does the PayMedix billing process work?
Each employee receives one simple, consolidated monthly statement, the PayMedix “SuperEOB®”, that includes all medical treatments from all providers.
- Eliminates a blizzard of separate and confusing bills
- Makes it easy for employees to understand exactly what they owe and why
Why should I consider PayMedix?
PayMedix gives you an easy way to enhance your benefits package by helping your employees access and pay for the care they need for themselves and their families. So they’ll be healthier and more productive.
What do I need to do to implement PayMedix?
PayMedix is simple to implement.
- Works with any existing PPO or HMO network in the country
- No changes required to network contracts
- Integrates with supplemental coverage, financial accounts, and payroll systems
How does PayMedix provide support if employees have questions?
PayMedix has a dedicated customer care team who is always here to help your employees understand and use their benefits.
How do employees access their PayMedix account?
Employees have online access and can:
- Make easy payments securely via their bank or PayPal account
- Quickly access bank information in the online wallet
- View current and historical statements as well as additional claim-level details
- Easily search for PayMedix in-network providers
- Visit the Help Center 24/7 for FAQs and step-by-step instructions
What does it take to bring PayMedix to our employees?
- You can turn on PayMedix at any time. No need to wait for Open Enrollment
- Have your TPA/health plan turn off their EOBs and send the information to us
- We can coordinate with HRA/FSA/HSA incentive accounts as you direct. This can further improve the employee experience.
How many TPA’s are you working with currently?
The PayMedix model has been a Wisconsin-based healthcare payment solution since 2008, and we currently have connections with 16 TPA’s.
How do consumers like the program?
Consumers love it. In fact, PayMedix has a remarkably high net promoter score of 75, which is unheard of in this industry.
How would we implement PayMedix?
PayMedix has a full implementation staff that would work with your Operations, Finance and IT Leaders to ensure the proper team from your side is involved. Once that is determined, we will then meet for Discovery, Testing, and Implementation. Implementation can take anywhere from 7 weeks to 6 months depending on the data format that is received and the resources available.
Will PayMedix have dedicated customer service for consumers and providers?
Yes, we have a fully staffed customer care center as well as self-service available on our website.
Where is PayMedix most prevalent?
PayMedix is most prevalent in Wisconsin. However, we are happy to review your book of business to determine where we should focus.
What is the cost?
PayMedix is funded primarily by providers who no longer need to collect member receivables as a result of the benefits the PayMedix solution delivers.
How will consumers be educated about PayMedix?
We have a dedicated Client Engagement Staff to help employers learn how to take full advantage of our product.
Who will handle 1099’s?
We rely on the TPA to continue this practice, but are open to discussion.
How do provider payments flow?
All provider payments will flow through PayMedix.
Is this for all claims?
This is currently for medical claims only.
Is the family-based statement HIPAA compliant?
Yes.
What is a “SuperEOB®” and how is it different from my normal medical bills?
The PayMedix SuperEOB is an easy-to-read monthly billing statement that consolidates all in-network charges for you and your family, no matter how many providers you visited. Instead of receiving multiple EOBs (Explanation of Benefits) and medical bills, the Super EOB summarizes all of that information so you can easily understand what you owe.
Why do I only get one medical bill per month?
At PayMedix, our goal is to make your medical billing and payment experience as simple as possible. That’s why we work to consolidate all your bills and claims so you only get one monthly bill and only have to make one payment.
Why isn’t claim information on my SuperEOB? Where can I find specific details on my claims?
The SuperEOB makes it as easy as possible to-read and understand your claims. However, if you still have questsions, you can access specific claim information on the second page of your SuperEOB, while there is even more detail available via your member portal account.
How do I know how much I’ve paid toward my deductible for the year?
The Third-Party Administrator (TPA) selected by your employer holds the balance of your deductible for both you your family members. Please access your TPA website at the address located on your PayMedix ID card or your SuperEOB.
How do I get in touch with PayMedix customer service to ask a question about a bill or claim?
Our Member Portal offers self-serve resources, as well as the option to contact us directly. You may also contact us through our main website or via email: INFO@PAYMEDIX.COM.
How do I pay my bill?
Pay online: Login securely to your account at PayMedix Online Access, or use the One-Time Payment feature. You can also use PayPal™, your checking or savings account, HRA, FSA, HSA, debit or credit card.
Call us: Pay securely by electronic check, debit card, credit card, HRA, FSA or HSA card. Customer care is available at the hours listed below (Central Time):
Phone: 888.477.7968
7 a.m. – 8 p.m. (Monday-Thursday)
7 a.m. – 5 p.m. (Friday)
9 a.m. – 1 p.m. (Saturday)
Mail: Send your check along with the remittance coupon from your SuperEOB® statement to:
PayMedix
Dept. 9200
P.O. Box 1450
Milwaukee, WI 53201-1450
What if I cannot pay my bill within 30 days?
If you are unable to pay your balance in full within 30 days, call us to set up an interest-free payment arrangement.
If you want to apply for financial assistance through PayMedix , please provide the following documents:
Copy of most recently filed Federal Tax return (I.e., pg. 1-2 of 1040 Tax doc) or W-2 for each member of household.
Copy of most recent check stub for each member of the household.
Proof of unemployment, Unemployment Statement, Disability and/or Social Security income for each adult member of the household.
*Qualifying for PayMedix ‘s financial assistance will not reduce your overall debt, but can reduce your monthly payments.
You can submit the forms by attaching them here or by mailing them to us at the address below:
PayMedix
1000 North Water Street
Suite 1100
Milwaukee, WI 53202
Why was my bill sent to collections?
If you have an outstanding balance with PayMedix, your bill may have been sent to collections for a variety of reasons, including but not limited to:
- an inability to come to a resolution on the outstanding balance
- an inability to connect with you via email, phone or USPS mail to resolve your balance
- a failed dispute of your outstanding balance due and lack of payment
Unlike most medical systems and providers, at PayMedix we have many options available to you to resolve your collections. Please contact us at 1-866-705-2383 so we may work through this issue together.
Why was my claim denied?
We can’t offer specific insight into why any individual claim was denied. However, if you identify discrepancies with how your claim was processed, you can file an appeal with your Third-Party Administrator. PayMedix will gladly work with you to understand why the claim was denied, and if desired, contact your TPA to go through an appeal process.