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Everything your billing office needs to work with a Catilize Health MERP: how the plan pays, where to verify eligibility, and how to submit the patient’s out-of-pocket balance for payment.
Eligibility verification
Verify a patient’s MERP eligibility in the provider portal, or call provider services with the patient’s name, date of birth and MERP ID.
Check eligibility in the portal → (opens in a new tab)Claims submission
Bill the primary plan first. Then send the primary EOB plus the itemized patient-responsibility bill through the portal or by fax. Payment is issued to your office within 30 days, typically two weeks.
Claims FAQ →Payments and remittance
Catilize Health pays the eligible balance directly to the provider. Direct deposit for members is set up through the member portal; for provider payment questions, call provider services.
Call provider services →How a Catilize Health MERP pays
The MERP is always secondary to the patient’s primary medical plan. It exists to cover what the primary plan leaves to the patient.
Bill the primary plan
The patient’s spouse-employer plan (first ID card) adjudicates the claim as usual.
Submit the balance to Catilize
Send the primary EOB and the itemized bill for copay, coinsurance or deductible via the provider portal or fax.
Catilize verifies and pays
Eligible service and in-network status are confirmed and the balance is paid to your office. No balance billing of the patient is needed.
Provider FAQ
What is Catilize Health, and what does the MERP pay?
Catilize Health is a third-party claims administrator for employer-sponsored Medical Expense Reimbursement Plans (MERPs), including plans your patients may know as SIHRA®, Spousal MERP™, NetZero Health Plan™ or another employer-branded name. The MERP reimburses the patient’s eligible copayments, coinsurance and deductibles on the primary plan, the spouse’s employer medical plan, up to the out-of-pocket limits set by the Affordable Care Act.
Which card do I bill first?
Bill the patient’s primary medical plan first (the spouse’s employer plan shown on their first ID card). The MERP is secondary and only reimburses the patient’s out-of-pocket responsibility after the primary plan has adjudicated the claim. The patient’s Catilize Health MERP ID card is presented second.
How do I submit the patient’s out-of-pocket balance to Catilize Health?
Submit the primary plan’s Explanation of Benefits together with the itemized bill for the patient responsibility through the provider portal, or by fax. Catilize verifies the service and the in-network provider, then pays the provider directly for the eligible balance.
How do I check a patient’s eligibility?
Use the provider portal, or call provider services on the toll-free number above with the patient’s name, date of birth and MERP ID.
How long does payment take?
Claims are processed within 30 days of receipt and typically within two weeks. The patient may receive another statement from your office while payment is being processed.
What if the patient already paid at the time of service?
If the patient paid their copay or balance in the office, they submit the receipt and EOB to Catilize themselves and are reimbursed directly. No action is needed from your office.
Mailing address: Catilize Health, 2605 Nicholson Rd., Suite 1140, Sewickley, PA 15143. For general (non-claims) enquiries use the contact page.
Questions about a claim?
Provider services can help with eligibility, claim status and payment.