Provider portal pointers: Submitting an eligibility and benefits request

This is a new ongoing series of tips and tricks designed to help you do your job more efficiently by getting the most out of the applications and tools available on our provider portal.

Using our provider portal, availity.com,** to determine patient eligibility and benefits helps you more quickly get the information you need to service your patients. However, if you’re new to our provider portal, or only need to access patient benefits and eligibility infrequently, you may have questions.The Eligibility & Benefits page has two useful tools to help you complete your request: Watch a demo and Find Help.

To get to them, let’s first look at the My Account Dashboard.

The My Account Dashboard lets users:

• Determine what applications and features they can access.
• Update their profiles, upload pictures and reset their passwords.
• Confirm organization administrators.

How to gain access to Eligibility & Benefits

Your organization administrator must grant you access to the Eligibility and Benefits role under Manage My Team(s).

To locate your administrator, hover over Manage My Team(s) and then click on I need access. This will display who controls your access. Or do the following:

1. Click on My Account.

2. Click on Organization(s) under the Personal Settings menu.

 

3. Click on Open My Administrators.

How to get to the Eligibility & Benefits page

1. Log in to the provider portal at availity.com.**
2. For all lines of business, click on Patient Registration on the menu bar and then click on Eligibility and Benefits Inquiry.

Lines of business include Blue Cross Blue Shield of Michigan (PPO) and Blue Care Network (HMO) commercial, BCN Advantage℠ and Medicare Plus Blue℠ (Medicare Advantage), Flexlink, out of state Blue Cross Blue Shield of Michigan plans and Blue Cross and Blue Shield Federal Employee Program^® (FEP) contracts.

On the Eligibility & Benefits page you can choose to either watch a training video or access detailed step-by-step instructions on how to submit a request.

How to view the training video

1. Click the Watch a demo link.

2. Click the Start Course button.

How to view detailed step-by-step instructions

1. Click on Help & Training on the menu bar and then click on Find Help.

2. Click on Submit an eligibility and benefits request.

Eligibility and benefits request tips and tricks

• When searching for FEP or out-of-state (include prefix) coverage, search by Patient ID, Patient Last, First Name and Date of Birth using the Single Patient tab, not the Member Search tab.
• In the As of Date field, enter the date for which you’re verifying the patient's eligibility and benefits information. In many cases, you can enter a date up to 24 months in the past and up to the end of the current month for the future.
• For members with multiple groups, be sure to select the group and service type to view the benefits. Eligibility inquires for prior coverage are based on the contract number.
• In the Benefit/Service Type field, select the type of benefit or service for which you want to determine a patient's eligibility.
• Tip: Plan coverage code 30 is the most commonly used because it returns more than 10 different benefit types.

Be sure to look for more provider portal pointers in future issues of this newsletter.

**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.

Availity^® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal and electronic data interchange services.