Fine-tuning Your Reimbursement Workflow

(UPDATED: 06/22/22)

Thanks for sticking with me for Part Three. This blog series will help you fine-tune your healthcare reimbursement workflow. You won’t need all these details. “Pick” out what helps you.

Don’t fret. I’ll try my best to help you bridge the gap between what you read and what you may start doing. The file naming system and the spreadsheet are key.

I have a free checklist (that I hope will help you) to download at the end of this post.

Your Workflow

Open up my free spreadsheet to follow along with this explanation. (I updated the spreadsheet since writing Part Two. You’ll want this newer version with the “Amount Paid” column. I also have better examples in the “dummy data.”)

Get Ready

I recommend gathering everything you need before submitting a healthcare reimbursement to P&A. The site will time out if you take “too long.”

Record expenses as they occur in your spreadsheet

The best way to keep on top of your paperwork and obligations is to record appointments, purchases, mileage, et cetera, as they occur.

• In your spreadsheet, put in the date and what you want to reimburse. Keep the sheet in chronological order.
• When you submit a claim, start a row with the date and put the UPV number in Column D (What).

Again, following along with the sample will help you understand this post. Part Two, Staying on Track with a Free Reimbursement Spreadsheet, describes the tabs and columns for the spreadsheet.

Consider color-coding your spreadsheet

Red values in the spreadsheet catch my eye next time I sit down to work on a reimbursement. Any rows with red values have “pending” in the “Done” column. (For instance, I often submit a reimbursement before paying a medical bill.) I use “yes” when everything is done. My current red values remind me to:

• Find a receipt for my next submission.
• Ask my doctor for a medical necessity letter.
• Call the doctor about a bill.
• Check with BCBS about an unprocessed EOB.
• Submit documentation to clear a denial.

Keep your documents scanned, named, and filed

As you collect receipts and invoices, I recommend scanning them right away. Also, follow the filing and naming systems from Part One, Organizing Reimbursements, so you can find what you need.

Keep all your doctors’ medical letters in a separate folder

Make paper and digital folders for the letters of medical necessity from various doctors. I have several letters for various supplements I take. Again, use the naming convention. I saved a PDF of my doctor’s letter with the date of the letter, doctor, and item: “20210505 Hartman for eyes.”

These letters are only good for a year window. Make sure your letter matches the time frame of your claim.

Take time to make a digital folder of maps for mileage

I’ve found the best way to submit a mileage reimbursement is to have screenshots of your routes. Look up your starting address and the destination address. Get directions on Google and take a screenshot. Crop to size if you wish and make sure the addresses are clear. Place these in a digital folder. I recommend a naming system again. Mine includes an abbreviated destination and a route (If I use different routes). 

Keep your commonly-used addresses in the mileage tab on your spreadsheet.

You’ll use these often, even from year to year.

Medical mileage worksheet

I prefer to upload maps with EOBs or receipts. It’s the most straightforward for me. If you prefer to use the worksheet instead of the maps, follow the directions. Find the instructions and worksheet here. (Go to StaffWeb/Healthcare Reimbursements/Tools for the latest medical mileage rate. It changes every year.)

For two different ways to record mileage in your spreadsheet, see the blue and orange claims in my sample spreadsheet.

Create explanatory notes

I’ve also created explanatory notes (as a PDF file) if I thought it would help. These optional notes have been helpful to avoid a denial or to include when I re-submit a denied claim. Here’s some things I’ve done:

• I bought orthotics at a shoe store so I wrote an explanation on my map to reimburse the mileage.
• Wal-Mart receipts are cryptic (see NOTES). I wrote out the items and costs on a blank paper and photocopied that together with the receipt.
• I wrote out explanations for several purchases in Word, saved it as a PDF, and included it with the required receipts for a claim.
• If I need to include an EOB as a receipt for mileage, I include an explanation that it is a receipt. Once, a processor assumed it was a duplicate EOB and subtracted the amount from my claim total.

Want to put your notes on your PDF? Try PDF 2 Go for free. I thought hand-writing was easier.

Submit Your Manual Claim

(The steps for accepting and recording an EOB is in Part Two of this series.)

It’s important to have everything ready to avoid P&A timing out.

Also, make a careful calculation of the total amount you’re going to claim. If you added wrong or don’t have the document for an item, you’ll have to back out of the claim to change the amount. This erases everything you may have done for the submission. You’ll have to start over.

I recommend doing one claim with up to ten items and then waiting a few days before doing another one. I did several on one day which was paid out in a lot of small checks. It was very hard to verify what was what.

• Look through your spreadsheet, marking what items you’ll reimburse (only ten allowed per claim).
• Check that you have all the documentation you’ll need for these items.
  • Receipts.
  • Optum Rx invoice.
  • Medical necessity letters.
  • Maps.
  • Mileage, tolls, and parking information.
  • Etc.

• Note the beginning and ending dates.
• Calculate your total. Re-calculate your total.
• The only way to enter P&A is through the link on the StaffWeb. Go to Pay, Benefits / Healthcare Reimbursements / P&A / “here.”
  • Click on “Upload Claim/Documentation” under the Quick Links on the left.
  • Click on the “New Claim” button. (The Claim Response button is what you’ll click on to clear up a denial.)
  • Follow the prompts as you work chronologically through your spreadsheet and files.
• Copy the UPV number to paste into your spreadsheet at the end of your submission.

After Submitting

Save a copy (optional)

If you want to save or print a copy, your only option is the Download option. P&A downloads a TIFF file, which is huge. When you want to view your uploaded files, do so:

• right after submission or
• later, by opening the link for the claim on P&A’s dashboard.

However, if you try the “save PDF” option for either of these, you only receive one page at a time.

I use the last option because I can find all my needed information in my spreadsheet and files.

Enter data in your spreadsheet

Since I don’t save a copy of the claim, I carefully mark my spreadsheet.

Paste the UPV number in column D. Enter the date of the claim and the amount of the claim. Notice, I use columns I through L. See a just-submitted claim sample in rows 17 – 20.

Use the same color for a group of line items for a claim. After a claim is complete (in the bank), you may keep or remove the colors. See the orange, blue, and yellow claims in my sample spreadsheet. I’ve kept the colors for some confusing claims that I need to look back on.

You can hide columns that you aren’t using since this spreadsheet is so wide. Remember to unhide later.

Phone calls, emails, and letters

Organize your inbox and email folders.

• Label emails with a financial label in Gmail.
  • Archive emails when you’re done with them. An active email might be an ongoing conversation about an expense or a bank deposit you need to record.

Keep using your spreadsheet! Use the last two columns in the spreadsheet for notes:

• • Do I need to call the doctor’s office or find a lost receipt?
  • Record dates of phone calls, chats, letters, and email notifications from Cru, Blue Cross (BCBS), and P&A.

Finishing up

Everything has gone smoothly. The amount you requested is headed for the bank. It’s time to finish recording this claim in your spreadsheet. I use column M for:

• BCBS claim numbers when P&A posts that information and
• for confusing manual claims when a claim is broken into smaller amounts.

Put the date your funds are deposited in “In the Bank” (N) and the amount paid in column P. Change “Done” (O) to “yes” if EVERYTHING is done. Bills paid. Refund received. Whatever.

If your claim is broken up, see the yellow claim in my sample spreadsheet. Key in the actual amounts deposited (P). It’s helpful to keep this claim color-coded in case you need to go back. I’ve had several very confusing situations where this helped me.

Denials

It takes a while for P&A to mail you a denial letter. If you don’t want to wait for the letter, look in the “Account Details” for the “Claims Submitted” tab. Look under the “Remarks” for “Denial Details.” Click on this link for the denial letter and “Save as PDF” and file it in a digital folder. 

I named the PDF “20210427 Denial 868”. That is, claim date (according to P&A), “denial” and the amount.

Follow similar steps for submitting a manual claim to justify an expense:

• Have your files ready and calculate your total.
• Click on the “Claim Response” button for processing the files needed to clear your denial.
• P&A offers a drop-down of the denials for you to “pick” from.

The orange claim in my sample spreadsheet shows how to record a denial in your spreadsheet.

Miscellaneous

Like many of you, I’m the spouse that does all our healthcare reimbursements. Mike doesn’t have very many things to claim, so I sit with him to do his. I want him to know how to handle healthcare claims if something happens to me. Visit Workplace (Benefits Forum) for help from others who are managing family expenses.

Free Healthcare Reimbursement Checklist

I know you have a lot of pluck because you’ve made it this far! Thank you! It’s taken quite a bit to prepare for you. I don’t want to overwhelm you.

I made two Tables of Contents to make it easier to find what you need.

I also made a checklist. Keep the checklist handy for your next submissions. The links in the checklist will direct you to the blog posts. Refer to any details you might need in the blog series. 

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NOTES:

• The P&A Healthcare Reimbursement Series:
  • Part One offers a way to organize and name your files and PDF documents. I give a brief outline of a workflow.
  • Part Two is where you download a free spreadsheet. I give a brief overview on tracking reimbursement details. I include steps to approve an EOB.
  • This post, Part Three, amplifies on the workflow and on the spreadsheet. Learn about tracking a manual submission. Download a free checklist to tone down all these details.
• Other helpful tools:
  • Use the Wal-Mart app to decipher those abbreviations on their receipt. You’ll want to include an explanation of the items when you submit a claim.
• I recommend the chat service for a quicker connection with P&A. Also, you can save the chat conversation and have it emailed to you.
• Want to learn more about spreadsheets? I have lots of help on eQuipping for Ministry. Why not start with some easy training from my good friend, Bob MacLeod? Start with Excel / Google Sheets Tips & Tricks 2019.
• Photo by Angela Pompermaier on Unsplash