For providers: How can I get patient information over the phone?
Who is this for?
If you want to get patient benefits, eligibility and other info over the phone, you can use our automated response system.
We give you different ways to get patient information about our members. Many providers use web-DENIS. You can also call PARS, the automated response system that replaced CAREN. It allows you to get patient info by speaking or entering information and then following prompts.
What can I do using the automated phone system?
The system will ask if you want to hear:
- Eligibility and benefits for your patient
- Deductible, copay and other cost share amounts
- How much a patient has paid toward their deductible, coinsurance and other cost share
- Info for another patient
- Coordination of benefits info
- Whether Medicare is a patient's primary plan, and their effective dates
- The mailing address to submit a claim from outside Michigan
If your patient has one of our PPO plans, including Medicare Advantage and FEP, you can request a fax or email with eligibility and benefits. Unfortunately, this option isn't available for patients with Blue Care Network HMO coverage.
To hear all available information about a patient, you need to enter your provider identification number, facility code, NPI or tax ID when you call. Without it, you're limited to eligibility and benefits. You can find out exactly what you need below.
How to call the automated response system
Here are the phone numbers you need and some helpful information. Choose your provider type to get started.
Will I be able to speak to a live person?
Keep in mind the system is designed to deliver information first. You'll get the best results if you follow the prompts.
Because it's interactive, the prompts you get will be based on your responses. That means in some cases, speaking to a representative may not be offered as an option. After you've listened to a patient's benefits, if you still have questions say "CSR" or "representative." You'll be transferred to someone who can help.
Can I get precertification and preauthorization using the automated phone system?
Facilities in Michigan: You can use the automated system to get precertification. Only three facility benefits may require precertification: acute inpatient, skilled nursing and rehabilitation.
When you call, you'll hear whether precertification is needed based on the patient's plan. If it is, say "precertification" and answer the questions that follow so the system can get you to the right department for precertification. You can find more information about precertification in your provider manual.
Professional providers in Michigan: If you think preauthorization is needed for a procedure, you should start by looking in your provider manual. The automated system isn't set up to help you with preauthorization.
All providers outside of Michigan: You can get information about precertification and preauthorization using our medical policy application.