Transaction Capabilities

• Eligibility verification
• Member benefit verification
• Preauthorization submission and approvals
• Claims submission and status
• Claims tracking
• Referral submission and approval
• Submit a complaint
• Submit contact information changes

Electronic Medical Records

• Member profile management
• Member health history
• Diagnosis and test reports sorted per specific test and/or time
• Download and upload medical reports

Inquiry Capabilities

• Plan benefits
• Benefit limitation status
• Patient search

Provider Portal Benefits:

Improves the Efficiency of your Providers

• Lets them instantly view up to date patient eligibility and benefit information
• Reduces their bad debt for services provided to ineligible patients
• Lets their billing staff perform administrative work (eligibility, claims tracking, etc) during off hours
• Receive authorization and referral approval in real time
• Improves Plan Efficiency
• Frees up your phone lines by eliminating eligibility and claims status calls
• Prevents incomplete claims from being submitted
• Allows providers to correct claims errors prior to submission
• Routine authorizations and referrals approved electronically using your business rules
• More complete claims result in faster average turnaround

Reporting Capabilities

• View provider performance against established benchmarks
• Providers can view complete claims history of their patients (if authorized) improving the care received by your members