PCP and Specialist CAP Rosters Guide

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1 PCP and Specialist CAP Rosters Guide Independence Blue Cross offers products directly, through its subsidiaries Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield independent Page licensees 1 of of 5 the Blue Cross and Blue Shield Association.

2 This user guide contains information for both the primary care physician (PCP) CAP Rosters and Specialist CAP Rosters transactions. Note: Through 2015, IBC will be in the process of migrating members to a new operating platform. During this time, information may vary for migrated versus non-migrated members, as indicated in this guide. For more information about our business transformation, go to PCP CAP Rosters The PCP Cap Rosters transaction allows you to view, download, and print monthly member capitation rosters for the PCP provider groups associated with your office. Rosters will include information for migrated and non-migrated members. Important notes: If you are enabled for electronic funds transfer (EFT), you will no longer receive a paper roster for migrated members as of. All EFT-enabled providers are required to access their capitation rosters for migrated members using the NaviNet web portal. Capitation rosters will include information for both migrated and non-migrated members. You will receive two separate payments each month one for migrated members and one for non-migrated members until all membership is migrated to the new platform. Accessing your PCP CAP Rosters 1. Select epayment from the Plan Transactions menu, and then PCP CAP Rosters. 2. Select the date of the report and enter the appropriate Provider or Tax ID. Then select Search. Please note the following: You cannot search by both Provider and Tax ID. Click inside of the Select Provider field and type in your search criteria. The type-ahead feature will narrow your results as you type. Rosters will be available after the 10th of each month. You will 13 months of historical data available to you. Page 2 of 5

3 3. Next, view the PCP CAP Rosters Summary screen. The Summary section includes the combined capitation payment for migrated and non-migrated IBC members. To download the summary and detail information, choose either the PDF or TXT button, depending on the format you prefer. 4. Select the Eligibility and Benefits link to verify member copayment and benefits information. 5. In the Detail section, you can sort columns by clicking the headers. You can also select the magnifying glass in the Search field to filter results by any of the following categories: member last name, member ID number, CAP rate, CAP payment, plan, or provider ID. Capitation Statement Page 3 of 5

4 Specialist CAP Rosters The Specialist CAP Rosters transaction allows you to view, download, and print monthly member capitation rosters for the specialist capitated providers associated with your office. Important notes: If you are enabled for EFT, you will no longer receive a paper roster for migrated members as of. All EFT-enabled providers are required to access their capitation rosters for migrated members using NaviNet. Capitation rosters will include information for both migrated and non-migrated members. You will receive two separate payments each month one for migrated members and one for non-migrated members until all membership is migrated to the new platform. Accessing your Specialist CAP Rosters 1. Select epayment from the Plan Transactions menu, and then Specialist CAP Rosters. 2. Select the date of the report and enter the appropriate Provider or Tax ID. Then select Search. Please note the following: You cannot search by both Provider and Tax ID. Click inside of the Select Provider field and type in your search criteria. The type-ahead feature will narrow your results as you type. Rosters will be available after the 10th of each month. will be the first Specialist Cap Roster available on NaviNet. You will eventually have 13 months of historical reports available to you. 3. Next, view the Specialist CAP Rosters Summary screen. The Summary section includes the combined capitation payment for migrated and non-migrated IBC members. To download the summary and detail information, choose either the PDF or TXT button, depending on the format you prefer. Page 4 of 5

5 Capitation Statement 4. Select the Eligibility and Benefits link to verify member copayment and benefits information. 5. In the Detail section, you can sort columns by clicking the headers. You can also select the magnifying glass in the Search field to filter results by any of the following categories: member last name, member ID number, CAP rate, CAP payment, CAP type, provider ID, or PCP name. Tips When conducting transactions from IBC NaviNet Plan Central, search results will include information only for members covered under IBC plans. Please ensure you have access to all applicable health plans you do business with. To download a report, you must have the appropriate security settings. Contact your IT administrator if you need assistance. The information generated through this transaction is intended to be a snapshot in time and not real-time information. NaviNet is a registered trademark of NaviNet, Inc., an independent company. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Page 5 of 5

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