FABOH provides a health care network � we offer access to many health care providers and facilities at reduced rates. FABOH members should present their health plan ID card with the FABOH logo when they visit a provider.

Medical (except prescription drugs) claims are sent to the FABOH claims repricing unit so that the fees on the claim can be adjusted based on the negotiated fee. Within three business days , the claim is sent to the claims administrator for processing and payment, if applicable.

FABOH does not:

• Provide health insurance;
• Pay claims;
• Determine whether a claim is eligible for coverage under an employer's benefit plan;
• Pre-certify inpatient admissions; and
• Reprice claims for prescription drugs, or claims for individuals with primary coverage under Medicare.

1. The patient visits the health care provider.
2. The health care provider submits the claim to the claims repricing unit (The Alliance)
3. The claims repricing unit reprices the claim and forwards it to the Claims Administrator within three business days for processing.
4. The Claims Administrator processes the claim and sends an Explanation of Benefits (EOB) to the patient. If applicable, the Claims Administrator, pays the provider.
5. The provider bills the member for co-pays and deductibles.

 

Mailing Address for FABOH claims:

CHP/RPU
P.O. Box 46487
Madison , WI . 53744-6487

Fax line for FABOH claims:               (608) 210-6677