Thursday, February 19, 2015

IBM OneExchange Claims Processing Issues (and why I use FAX)

I know, I know --- how geriatric am I --- I use a fax machine to submit my claims.  How antique.  I also do not do recurring/automatic payments.  I am faxing claim submissions for several reasons.
I can quickly and easily talk through claims processing errors with OneX while making notes on the submission claim form so that there is a clear record of my interactions.  I skip the snail mail cost of stamps and printer ink to make copies of claims and documentation by faxing. Mostly, I believe it will be a lot easier for my family to know exactly what claims I have submitted and read about all my conversations with OneX by just looking at my hardcopy claims folder if I am unable to do it.  My spouse is totally cantankerous about this IBM transition (read that as ornery), resents the HRA funding process and would abandon the reimbursement rather than dig around my computer to figure out the process. I've warned the kids about it but when I try to show the process to them their eyes glaze over. My feeling is maybe my hardcopy folder will help them quickly understand the process and history. However, I have reconsidered my position on recurring payments and decided I should enroll in those payments just because of that last reason. It would mean that at least the insurance premiums would be automatically reimbursed if I am unable to submit claims and no one else takes the time to file claims.  Anyway,  OneX also made a lot of mistakes last year.  Unfortunately, the mistakes continue.
In January, a processor rejected one of my claims saying there was inadequate documentation.  I called OneX and the call center rep went through the fax image of the claim.  She  said the processor clearly made a mistake and she'd send it in for review.  I never heard about that claim again. Two days ago, two of my claims were rejected for the same reason.  The call center rep I spoke to yesterday said the fax pages must have not transmitted.  When I asked if he went through the fax image to see if they had transmitted, he admitted he did not.  But, it didn't matter, he said, since the only way to get all three claims reconsidered was to resend them to OneX.   Sigh.
It's not a big deal to resubmit the claims, just annoying.  They are premium payments so I am going to do the recurring/automatic payment process for all our premium payments to try to curb the processing errors as well as deal with my recalcitrant spouse. 

Well, I, once again, am an idiot.  No matter how many times the call center representatives give me incorrect information I continue to believe them.  I called OneX to activate Automatic Reimbursement for the policies we bought through OneX thinking she could just "do it" and I wouldn't have to troll around the website.  The call center rep told me I had to submit a recurring reimbursement form.  I asked if I could do it online but she told me I needed to send in the form. She said she could just mail me the form or I could get the form online but I had to send in the form. She never asked nor did I say we bought the policies through OneX. I assumed (there I go again being an optimist) she could see it in our account. I had some forms they sent out last year so I didn't need to go online. After I faxed the form I decided to read the back of it and the form doesn't apply for policies we bought through OneX. Then, I decided I should just go online and see how to activate it.  It is embarrassingly simple.  Duh. 


  1. Don't forget about applying for recurring expenses for the MEDICARE payments.(104.90) for you and your spouse. That 209.80 each month helps get the HRA down quicker. The biggest issues I've had with that is they accept 1 of them and deny the other one a a duplicate. Once I called them and explained there are 2 of us any ask them to look at the form for who the reimbursement is for, then they have resolved it. I seems as though ONEX continues to have its issues. Never thought I would be keeping detailed records and using spreadsheets this much just to protect myself.

    1. My spouse gets SHAP so it it's just me for recurring expenses right now. I totally agree with you ... never thought I'd have to be so diligent about tracking everyone ... insurance, doctors, hospitals and OneX. It is unfortunate but I hope people understand there is no automatic goodness anymore.

  2. I hope you are not eligible for SHAP assistance to pay your Medicare Part B premiums. We have had issues when the retiree went to submit their SHAP fom while they are being reimbursed from their HRA for the same premium. To Acclaris, the processor for SHAP , it looks to them like the Retiree is trying to double dip and that is a No No.
    IBM has gone so far as to change the SHAP form, both pages, to discuss HRA/SHAP reimbursement. The say on page 2 that they Recommend that if you have SHAP, then request that first and after you get your $900 you can submit the balance of $358.80 to your HRA account. It does not work the other way. I wanted them to use the word MUST instead of recommend but they don't want to be that specific in telling you what to do.
    One Exchange has also added the same warning on the instruction sheet for the Recurring Reimbursement of Premiums form.
    See my posts on the Yahoo/IBM msg boards ibmpension, ibmretiree to see how to recover from the problem you will have. I have also put this on my Google files list per Plato's instructions and it should also be there if I did it correctly.

  3. Plato,
    Did I do the file transfer correctly regarding Rcovery from HRA first and SHAP 2nd for Part B Medicare?

    Roger aka Attila the Hun

    1. Please reply with the web page links to the documents that are in your Google docs and I will put them into a blog post to tell people were to find them. Although the docs are "public", without the links the docs will be impossible for someone to find. Please reply with the links and I will copy, paste them into a new blog posting.