How Can I Maintain Compliance with Proof of Coverage Requirements for Reimbursements?
To stay compliant and ensure reimbursement approvals on the Take Command platform, it is crucial to understand the requirements and the process for managing proof of coverage submissions. Below is an overview of the key aspects, guidelines for submission, and answers to common questions for managing your proof of coverage.
Staying compliant in the Take Command platform ensures you can easily upload reimbursement claims, access account features, and avoid payment declines. Compliance also involves addressing non-compliance issues effectively to avoid disruptions.
Overview of Proof of Coverage Requirements
Your proof of coverage serves as the primary document verifying your active health insurance under your plan. Regularly updating this document ensures you remain eligible for reimbursement or AutoPay. Additionally, your proof of coverage should specify the metal tier of the plan (e.g., Bronze, Silver, Gold), include provider logos, and indicate whether any dependent coverage is included.
Additionally, for users enrolled in Medicare, proper proof of Parts A, B, and, if applicable, Part D is necessary to maintain compliance.
Approval of proof of coverage is not indefinite. Expiration dates require periodic resubmission of documents.
Submissions are reviewed by the Compliance team based on a submission queue, and approvals or requests for additional documentation are communicated once the review is complete. Once a document meets all requirements, no further action is needed. Users will receive an email notification confirming the review status.
Frequency and Timing of Submissions
The required frequency of updating your proof of coverage depends on your company's compliance configuration:
Regularly check your account dashboard for compliance status updates. This will help ensure that your submissions align with active requirements and avoid delays.
Quarterly Submissions: If specified by your employer, you may need to submit proof four times per year, typically before or on January 1, April 1, July 1, and October 1 to maintain active reimbursements.
Annual Submissions: A single proof of coverage document might be valid for one year if configured by your company. The uploaded proof will remain valid until its expiration date and must be renewed accordingly.
Instructions for Uploading Proof of Coverage
Follow these steps to update your proof of coverage:
Log in to the Take Command member portal and navigate to the Health Insurance section.
Use the Edit icon to update your plan details.
Upload a document that: - Is dated within the last 30 days, - Clearly shows your name, insurance company, and active coverage details.- Specifies the metal tier and provider logos.
Includes a backdated coverage statement if claiming premiums for past months. If navigating a new system flow blocks you (e.g., while shopping for a future plan year), use the back buttons in the process to select other upload options and return to the correct menu.
Confirm that the uploaded document pertains to the upcoming plan year if re-enrolling or renewing (rather than submitting the current year’s proof).
Once uploaded, the Compliance team will review your submission and notify you of its approval or if additional information is needed. Valid proofs will be approved without further user action, but claims previously denied due to missing or invalid proof must be resubmitted after compliance approval.
Be sure to monitor your dashboard for the updated compliance status after submission. This ensures that your account accurately reflects the approval, enabling timely access to reimbursements.
Common Questions and Troubleshooting Additionally, following platform migrations, such as the transition from "Take Command" to "HRA Hub," ensure all compliance submissions are routed through the updated platform to avoid issues. Employee statuses, such as "waived" or "non-compliant," are best verified in the HRA Hub. For users associated with Medicare, ensure submission of all required documents, specifically Medicare Parts A, B, and D (if applicable), directly in the platform. Submitting this documentation helps in resolving compliance quickly and avoiding claim disruptions.
Rejected Documents:
If you receive a message stating “Unable to Approve Your Claim”:
Verify that your document is dated within the last 30 days.
Check that the metal tier, provider details, and premium amounts (if applicable) are included.
Correct any missing elements and resubmit your proof of coverage.
What if my proof of coverage expires?
You need to upload a new document as soon as possible after your existing proof expires. If your proof changes to an "expired" status, update your plan details and resubmit immediately.
Do automated email images confirm approval?
No, automated email images do not indicate approval. Only submission reviews completed by the Compliance team confirm approval. Ensure your document meets all requirements, such as being dated within the last 30 days.
Do I upload proof of coverage again for a new plan year?
Yes, proof of coverage is required for every new plan year, even if you recently updated your plan setup. This ensures accurate validation of your premium for reimbursement or AutoPay.
By adhering to these guidelines, you can ensure your proof of coverage submissions are timely and accurate, minimizing disruptions to your reimbursement process.