Medical Eligibility & Benefits Lookup Tips

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Clifford Lester
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Medical Eligibility & Benefits Lookup Tips Excellus BlueCross BlueShield requires providers to use its self-service tools to determine patient eligibility and benefits.

Below is a summary of how to look up patient information in the Provider Portal: View patient details, including: Status - is this patient active? Primary Care Physician did this patient choose a PCP?

1 Medical Eligibility & Benefits Lookup Tips Excellus BlueCross BlueShield requires providers to use its self-service tools to determine patient eligibility and benefits. Provider Portal Note: Please see ExcellusBCBS.com/Providers > Provider News & Updates > Provider Updates > Required Use of Web Self-Service Tools as of April 12 for more information. Below is a summary of how to look up patient information in the Provider Portal: View patient details, including: Status - is this patient active? Primary Care Physician did this patient choose a PCP? COB does the patient have other insurance coverage requiring coordination of benefits? Has the patient met his or her deductible? What type of plan or product does the member have? Is this benefit covered? Is an authorization required? Provider Portal - Login From the Provider Home page, use the Login link or the Login or Register drop-down option to log in.

under Provider Home, or Choose Coverage & Claims and

2 Provider Portal Check Coverage Eligibility & Benefits lookup Select View Eligibility & Benefits under Provider Home, or Choose Coverage & Claims and then View Benefits & Coverage. Log in if you have not done so.

3 Provider Portal Check Coverage Patient Search On the Check Coverage screen, select the Patient Search section Use the Date of Service field to select a date to search. You can use: Current date Historical date Future date - five calendar days (e.g., today is March 1, 2017, and can search ahead to March 7, 2017) Enter up to three services or select the View all Services checkbox Enter or search for patient(s) (up to 10 patients at once) Click Submit to return eligibility and benefits details

guidelines Provider Portal Patient Information Eligibility Active status displays under Plan Information on the

4 Locate eligibility & benefits details quickly Patient information Eligibility status Subscriber ID Plan COB info and more Deductibles & out-of-pocket maximums Benefits details Quick links to policies & preauthorization guidelines Provider Portal Patient Information Eligibility Active status displays under Plan Information on the Check Coverage results screen. You can also view: Patient s PCP (if selected) Medicare information for Coordination of Benefits

Provider Portal Member Prefix / Product Type Member Prefix List From the

prefixes and his or her associated product type (PPO, etc.

5 Provider Portal Member Prefix / Product Type Member Prefix List From the Coverage & Claims screen, you can access Member Prefix List and view the Product Type. This list is available and provides a view of patient s three-digit prefixes and his or her associated product type (PPO, etc.) Member Prefix List Example: Prefix or Product Type Lookup The Check Coverage Search Results screen displays Plan Name and Subscriber ID member prefix:

Provider Portal Deductibles / Out of Pocket From the Check Coverage

Pocket Maximum information (found below Member Information).

returned based on the search criteria you entered (e.g.

Click View Additional Details link to view additional patient

6 Provider Portal Deductibles / Out of Pocket From the Check Coverage Search Results screen, you can also check Deductible & Out-of- Pocket Maximum information (found below Member Information). Provider Portal Benefit Details Benefit Details information is returned based on the search criteria you entered (e.g., three services or all services). Click View Additional Details link to view additional patient information. Use the Medical Policies and Preauthorization Guidelines quick access links to view policy and preauthorization details.

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