Office staff can search for a member using a wide range of criteria (e.g., member
first and last name, DOB, member ID and any other plan-specific criteria), or access
and print the member's plan benefit summary. Eligibility verification is fast and
efficient, with details provided on claims, authorizations, benefits and COB. Staff
can submit authorizations and referrals online and get instant information about
whether they have been approved, pended or denied.
Claims management is just as straightforward. Staff can auto-populate claims (HCFA1500 and encounter claim forms) with member and provider information to improve
speed and accuracy, then submit claims electronically. Approved, pending and denied
status can be easily viewed.