Claims Flow Process - An Overview

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 where the fees on the claim will be re-priced based on the negotiated fee. Within three business days , the claim is sent to the claims administrator for processing and payment, if applicable.

Mailing Address for FABOH claims:

P.O. Box 46487
Madison, WI 53744-6487

Fax line for FABOH claims: (608) 210-6677
FABOH repricing unit customer service: (877) 837-4245

Claims Flow Process - A Diagram

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

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
  • Reprice claims for prescription drugs or claims for individuals with primary coverage under Medicare