During claim submission there are various automated checks our system will do to validate claim information. You may receive a warning that your claim is being flagged based on one or more aspects of your claim info.
Attempt to resolve the error. If you cannot, you can select "Continue Anyway".
Claim Flagging Errors:
It seems the provided claim amount is not the payer total. Please ensure you are providing the payer amount.
Solution: We attempt to validate your claimed amount against the final owing amount on your benefits receipt or EOB*. First, if you are coordinating benefits, you can upload your EOB* as the primary receipts (first attachment) with the original receipt as your supporting document. Second, ensure the amount you enter during claim submission is the same as your final owing/outstanding amount. For example, if you are coordinating benefits with another insurer who has paid some amount against this claim, then enter the outstanding amount. If you still get this warning, you can select Continue Anyway.
The provided service date could not be found.
Solution: We attempt to validate your entered Service Date against the date of service on your benefits receipt or EOB*. Ensure the date you enter during claim submission is the same as the date on your attached document.
The provided patient could not be found on the receipt. Please ensure the patient name provided matches the patient name on the receipt.
Solution: We attempt to validate your selected Patient (from the first step in claim submission) against the patient name on your benefits receipt or EOB*. Ensure the patient you select during claim submission is the same as the patient on your attached document.
Oops, it looks like you have submitted the payment receipt. Please ensure you are submitting the benefit's receipt.
Solution: We attempt to validate your attached document as a valid and appropriate document to support your claim. Payment Receipts (like transaction records for card transactions) are not suitable receipts for your claim. Ensure you are submitting a more thorough and complete benefits receipt. More info can be found here.
The provided claim amount could not be found on the receipt.
Solution: We attempt to locate your claimed amount on your benefits receipt or EOB*. Ensure the amount you enter during claim submission is visible on your attached document, otherwise the document may not be sufficient to approve the claim.
The provided service date is more than one year old.
Solution: Claims for health benefits must be submitted within 365 days of their service date in order to be eligible. Ensure your entered Service Date is correct. If it is over 365 days ago, it is no longer eligible.
Our records show the patient has primary coverage elsewhere. Please ensure you are submitting to the primary coverage first before submitting here.
Solution: Claims must be submitted to the patients "primary insurer" (also referred to as the "first payer") before being submitted to their secondary insurer. A patients primary insurer is always their own employee benefits plan, unless they are a child-dependent**. After the claim has been settled, your benefits provider will provide you with an EOB*. Make a claim using your EOB and the claim system will detect this accordingly. **Child-dependents primary coverage is based on the birthday of the parents/guardians. The insurance from the parent/guardian who's birthday comes first in the calendar year will be the primary coverage for child-dependents.
*EOB = Explanation of Benefits: This is the document you receive from your Benefits Provider after a claim is settled. You use this to "coordinate benefits" with another benefits provider. EOB's are required for coordination of benefits, and your original benefits receipt will typically also be required.
If none of the above errors display during claim submission but you are encountering a problem:
- Ensure the file you are trying to submit is an image file (.png, .jpg, .heic), or a pdf. Any photo taken from your mobile device should be supported.
- Ensure you have fully filled any required fields
- Ensure the information you enter is as accurate as possible as we attempt to validate this info from your benefits receipt or explanation of benefits
- If you are using the mobile app, you may require an update - Simply Benefits updates "over the air" but may require you to force quit your app and restart it in order for the update to take effect (If you aren't sure how to force quit an app, restarting your phone also works.)
If you still can't get your claim submitted, contact us at firstname.lastname@example.org and we'll be able to help!