BlueCard Tutorial Eligibility & Benefits Search

Transcription

1 BlueCard Tutorial Eligibility & Benefits Search Blue Shield s Provider Connection site provides secure, reliable access to up-to-date eligibility and benefits information for out-of-state Blue plan, Blue Shield of California, and Federal Employee Program members. After completing the Eligibility & Benefits Search tutorial, you will be able to: Find eligibility and benefits information online for an out-of-state Blue plan member Understand eligibility and coverage information, including finding other coverage information and the claims mailing address Understand benefit information, including benefit limitations

2 page 2 of 16 Provide Connection Homepage Click "eligibility & benefits" To search for eligibility and benefits, click the Eligibility & Benefits tab in the top navigation bar. You may also click the More buttons, as shown.

3 page 3 of 16 Eligibility and Benefits Section home page To begin your search for eligibility and benefits, click the Verify Eligibility link or More button shown in the screenshot. Click Verify Eligibility

4 page 4 of 16 Verify Eligibility page To search eligibility for an out-of-state Blue plan member, first select Other Blue plan as the card type. Select Other Blue plan

5 page 5 of 16 Verify Eligibility page Then, indicate whether the member is the Subscriber or a Dependent. Select a member type

6 page 6 of 16 Verify Eligibility page Enter member information. All fields in the Enter section are required. Be sure to include the three-character prefix as part of the member ID. Enter all all member data data Patient Jane 08/14/1976

7 page 7 of 16 Verify Eligibility page Click Search. Patient Jane 08/14/1976 Click Search

8 page 8 of 16 Search in progress screen The Search in Progress screen appears while the search results are being retrieved. Note: If you don t want to wait for the search results, you can click Send Results to Message Center. Also, if the search takes longer than 45 seconds to complete, the results are automatically sent to your Message Center.

9 page 9 of 16 Eligibility & Benefits Search Results screen The system displays a list of members that meet the search criteria you entered. Click the Member Name to view eligibility and benefit details for the member. Patient Jane 08/14/1976 Click Member Name 05/25/2016

10 page 10 of 16 Eligibility & Benefits Details page Use the vertical scroll to view detailed information about this member s eligibility and coverage. Scroll down Patient Jane 08/14/ /25/2016 Patient

11 page 11 of 16 Eligibility & Benefits Details page Eligibility tab Patient Jane 08/14/1976 The Eligibility section displays information about plan type, current coverage, and effective and end dates. Other health insurance information displays if another insurance is primary. Review claims mailing address 05/25/2016 The claims mailing address displays in the right-hand column. 08/14/1976 Patient

12 The Benefits section displays detailed information about: Copayments Authorization requirements Benefit limits page 12 of 16 Eligibility & Benefits Details page Benefits tab 05/25/2016 home previous next

13 page 13 of 16 Eligibility & Benefits Details page Deductible / Out-of- Pocket tab The Deductible / Out-of- Pocket section lists annual limits and yearto-date accumulations for both the individual and the family. Year-to-date benefit accumulations for the service type and category you searched 05/25/2016

14 page 14 of 16 Provider Connection home page Click "Message Center" To view BlueCard responses that you sent to the Message Center -- or that the system did not return within 45 seconds -- click Message Center. The message center appears at the top navigation bar on every page you view in Provider Connection. Patient Jane 08/14/ /25/2016

15 page 15 of 16 Message Center page Messages are sorted by the member name shown in the Subject column. View details for any row by clicking the Subject link for a particular message. Note: Columns can be sorted by clicking on the column header. Click Subject link link 06/18/ /09/ /08/ /08/ /06/ /06/2016 PATIENT, JANE PATIENT, JOHN - AAA PATIENT, - AAA PAT, JOHN - AAA PATIENT, JANE AAA PATIENT, JOHN - AAA PATIENT, - AAA PAT, JOHN - AAA PATIENT, JANE AAA

16 Eligibility & Benefits Search Conclusion Congratulations. You have completed the Eligibility & Benefits Search tutorial. We encourage you to continue your learning. The BlueCard Tutorials web page contains other informative BlueCard tutorials, plus additional resources you may find helpful. Your online resources for: Member eligibility - Authorization request - Claims status - Or contact: BlueCard Eligibility at (800) 676-BLUE (2583) Authorization request - call the Medical Management number printed on the back of the member's ID card BlueCard Claims Unit at (800) Technical Support at (800)