ELIGIBILITY AND BENEFITS

Transcription

1 ELIGIBILITY AND BENEFITS USER GUIDE BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association

2 ELIGIBILITY AND BENEFITS USER GUIDE The HIPAA-compliant Eligibility screens in My Insurance Manager SM feature detailed information on deductibles, coinsurance, out-of-pocket amounts, copayments, lifetime summaries and more. The more specific the information you enter into the system (e.g., specific procedure code and diagnosis), the more specific the eligibility information will be on the Web screen. Log into My Insurance Manager. In the top menu under Patient Care, choose Eligibility and Benefits. 2

3 PATIENT SELECTION Complete the requested information to search for a patient. Be sure to enter the Member ID exactly as it appears on the patient s insurance card, including the alpha prefix. To choose a location, click the Select button next to the Location field. A list of locations associated with your Tax ID will appear. After entering the patient information, click Continue. 3

4 CHOOSE ELIGIBILITY VIEW There are three Eligibility and Benefits options: General Eligibility and Benefits; Eligibility and Benefits by Service Type; and Eligibility and Benefits by Procedure Code. General Eligibility and Benefits will display the results of a HIPAA Service Type 30, which displays benefits for 16 commonly searched service types. Eligibility and Benefits by Service Type lets you search by using a specific service type and diagnosis combination. Eligibility and Benefits by Procedure Code lets you search for benefits for a particular HCPCS code and diagnosis combination. You can not use facility revenue codes with this option. 4

5 ELIGIBILITY AND BENEFITS BY PROCEDURE CODE On this page, General Eligibility and Benefits is automatically selected for you. You can search and display benefits by specific specialties if you choose Eligibility and Benefits by Service Type. Or, you can search for benefits by Procedure Code. Remember, the more specific information you enter while searching, the more specific results you will receive. 5

6 ELIGIBILITY AND BENEFITS BY SERVICE TYPE Click on Service Type Code and choose your specialty. Enter your Diagnosis Code or search for one. Place of Service automatically defaults to Office-11, but you can choose the most appropriate Place of Service. Select your Service Facility/Billing Location. Enter your Rendering/Performing Provider if you know it. Click Submit. Remember, the more specific information you enter, the more specific results you will receive. 6

7 ELIGIBILITY AND BENEFITS BY PROCEDURE CODE Enter or search for your Procedure Code. Enter your Diagnosis Code(s) (if known) and select the most appropriate Place of Service, Service Facility/Billing Location and the Rendering/Referring Provider. Click Submit. 7

8 IN-NETWORK ELIGIBILITY RESPONSE Policy Effective Dates and Benefit Period display at the top. In-network benefits automatically display. You can click Out of Network to display that information. The patient s coverage status will display above deductible information. You will see benefit information categorized by Service Type. You can expand each section to show details about coverage that includes copayment amounts, coinsurance and special deductibles, if applicable. 8

9 OUT-OF-NETWORK ELIGIBILITY RESPONSE You can click Out of Network to display out-of-network benefits for a patient. If there are no benefits for a particular service, you will see a message that says, This patient is not covered for the requested service. 9

10 ELIGIBILITY RESPONSE For patients who have a Health Reimbursement Account (HRA), you will see a View HRA Information button. Click it to show the patient s HRA amount, including any messages on how his or her money is applied. Underneath the Eligibility Response and HRA section is the Global Deductible and Out-of-Pocket information for the policy. Be sure to check benefits for specific service types or procedure codes. Sometimes for a particular service, the deductible and out-of-pocket amounts will be different than for the global amounts. 10