Locating a member

Member information provides details of the subscriber's benefit plan. Some of the information displayed shows all dependents associated with the member, eligibility status, and the ability to add claims for them. You can also view the client benefit information. To view a member's information or to add a claim for a patient, you first locate the member.

1. Click View Patient Info/Enter Claims.
2. The Patient Info/Enter Claims screen appears. Enter the patient's member number (usually the subscriber's SSN. A few groups have elected to assign their own identification numbers to their members) in the Member ID field.
3. Click the Get Member Info button.
4. The Subscriber Information screen is displayed. See Viewing member eligibility and benefits for an explanation of the benefit information.

Viewing patient information

To view claims history for the whole family, view benefits, add a claim, or add a family member:

1. Locate the member as described above.
2. In the Subscriber Information screen, select Get Family Claims History next to the member name.
3. The Family Claims History screen appears. Enter the search criteria:
• Include — select the type of history you want view from:
• All claims — shows all claims submitted for the selected patient
• In-Process Claims — displays only claims that are in the processing state
• Pre-treatment estimate — shows all Pre-treatment estimates submitted for patient
• Processed — displays a list of only claims which have been processed
• Start Date — this is the date from which you want to begin your search
• End Date — this represents the last date of the time period for which you want to search
• Patient — displays a list of all members associated with subscriber; select the patient you want to search on from the drop-down list
4. Select Get Claim History. The search results appear at the bottom of the page.

Related Topics

Adding a spouse or dependent

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