Understanding Retroactive Reimbursements, Proof-of-Coverage Compliance, and Allowance Adjustments at Take Command
Take Command provides clear policies and procedures for managing retroactive reimbursements, ensuring compliance with proof-of-coverage requirements, and applying allowance adjustments. This guide outlines how these processes work and what steps you can take to resolve issues.
Retroactive Reimbursements
Eligibility and Documentation Requirements
Retroactive reimbursements are generally available as long as the coverage and service dates align fully with the backdated effective coverage period. To qualify:
Confirm service dates on the claims match the active coverage period, particularly the backdated effective date.
Upload all required documents to the Take Command portal, including proof of coverage that supports your claim.
Appealing Denied Claims
If claims are denied even after the approval of backdated coverage:
Contact the insurance provider directly using your member ID.
Request a review or reprocessing of the claims.
Be prepared to file an appeal if the situation warrants further action.
Exceptions and Reconciliation
In certain situations, particularly involving errors (e.g., incorrect default allowance amounts), retroactive reimbursements may involve recalculating the difference in allowances over prior months. These "catch-up" reimbursements are paid out over subsequent reimbursement cycles.
Proof-of-Coverage Compliance
Employees must submit valid proof of coverage to become compliant for reimbursement. Examples of acceptable documents include a monthly premium bill or elections/benefit statements.
Required Elements for Proof of Coverage
Ensure the submitted document includes:
The employee’s name (or their dependent’s name, as applicable).
Insurance plan name and provider/carrier (e.g., tier with the insurance company’s name/logo).
Premium amount, if requesting premium reimbursement.
A current date (a document dated within the last 30 days is considered current).
A statement of backdated coverage if retroactive reimbursement is being requested.
Common Reasons for Denial and Solutions
Claims may be denied for reasons such as missing carrier names. In these cases:
Resubmit the document with the correct information and all required elements.
If prior submissions are incomplete, address the specific reason cited in the denial before resubmitting.
Allowance Adjustments
Allowance adjustments often accompany life events like adding a dependent or changing premium tiers.
Prospective vs. Retroactive Adjustments
Allowance adjustments apply prospectively, meaning updated amounts are calculated starting from the approval date of your changes. Backdating adjustments for past months is not supported.
Life Event Examples: Adding Dependents
To add a newly-born dependent and request retroactive family rate adjustments:
Update your coverage tier (e.g., from "couple" to "family"), effective from the child’s birth date.
Upload proof of the life event (e.g., birth certificate) and updated insurance documentation reflecting the new premium.
Submit a formal request for retroactive reimbursement if adjustments are not processed automatically.
Related Topics
By understanding the guidelines for retroactive reimbursements, compliance with proof-of-coverage, and allowance adjustments, you can prevent issues and ensure smooth processing of reimbursements.