Provider Center Guide - Regence BlueShield

Provider Center GuideFor viewing member eligibility and benefit informationBeginning March 15, we will require dentists, physicians, other health care professionals and facilitiesto access the Provider Center to verify information regarding eligibility, benefits and simple claimsstatus. Customer Service will continue to be available to answer complex inquiries or questions youhave about the information you are unable to view online. Note:• Eligiblity and benefits for BlueCard® members are available by calling 1 (800) 676-2583.For claims status, please contact our BlueCard Customer Service team at 1 (800) 206-1244.SM• Benefits for KingCare members are available by calling National Alliance at 1 (800) 334-2583.For claims status, please contact our BlueCard Customer Service team at 1 (800) 206-1244.• For Federal Employee Program (FEP) member benefits, visit www.fepblue.org. For detailedinformation or questions, please contact our FEP Customer Service team at 1 (877) 668-4651.This guide includes screenshots to help you quickly find the information you need online.How to find eligibility information1. Begin by selecting the ‘Search for a Member’ link.• Enter the member number or the member’s last name and date of birth.• The results of your search will display the Search for a Member Result screen, showing themember’s coverage, including eligiblity information.1This screen willindicate if themember’s status is:Regence BlueShieldis an Independent Licensee of the Blue Cross and Blue Shield Association2344. Select the ‘View Coverage’ link to see details of the member’s benefits.2. Active -The member iscurrently covered.3. Termed -The member’s priorcoverage (includingthe end date).You can also view theeffective dates of themember’s current orprior coverage.

How to find benefit informationSelecting the ‘View Coverage’ link (see page 1) will direct you to the Eligibility and Benefits Summaryscreen. The following pages show sample screenshots of the sections that will appear on this screen.Note: Please verify each patient’s information online.Expanded member infoThis section provides an overviewof the member’s information.Any information we have for themember’s primary insurancecarrier, including the name andeffective date will be shownhere. Any pre-existing credits willalso be shown with the originaleffective date.In the dark blue bar at the bottomof this section, you can search foreligibility and benefit informationfor a prior date of coverage byentering the date and selecting‘Submit New Date’.Benefit Summary As ofThis section includes theproduct name, effective dateand status.You can also view themember’s applicablecoinsurance andcopayment information.Information is shown for:• In- and out-of-networkproviders• Upfront benefits• Emergency room• Childhood immunizations• Office visitsPage 2 of 4

Download PDF BookletsSelecting the ‘Complete Plan Booklet’ opens a PDF of the member’sBenefit Booklet which outlines all of the members benefits in detail.(This document can be several hundred pages in length.)Selecting the ‘Summary of Plan’ opens a PDF document thatbriefly describes the member’s benefits and exclusions.(This document is usually just a few pages. See sample below.)Sample Summary of Plan documentView medical multi-year accumulatorsTo view your patient’s benefit maximums, how much he or she hasused to date, and how much of each benefit is remaining, selectthe service from the drop-down menu. Then select ‘Submit’. Themulti-year accumulator information will be displayed below.Page 3 of 4

Accumulations As ofThis section indicates the member’sbenefits that have limits.For example, you can view thedollar amount or number of visitsa member has used to date andhow much of the benefit he or shehas remaining.Benefit BookletThis section provides quick linksto the information in the member’sBenefit Booklet.For example, by selecting‘Acupuncture’, you can see themember’s benefit for Preferred,Participating and Non-participatingproviders. The description alsoindicates the number of visits andany additional information.Learn morePlease see our Provider Center flyer for instructions on registering for this tool and a completelist of the information (e.g., claims status and payment vouchers) available to you online.Complete a system tour on our Provider Web Site at www.wa.regence.com/provider.March 2012