Whirlpool Service Line

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Presentation transcript:

Whirlpool Service Line HealthSCOPE Benefits 1-800-660-6212 CUSTOMER CARE REPRESENTATIVES Whirlpool Service Line 1-800-660-6212 M-F 8:00 a.m. – 6:00 p.m. EST Pre-certification/Pre-authorization Claim Status Eligibility Benefit Information Provider Network verification IVR- Available 24/7 1st Level Appeals

HealthSCOPE Benefits www.healthscopebenefits.com Click on Provider Enter WHIRL for group name Check on: Claim Status Eligibility Benefit Information Precert Information Copies of EOBs

Claim Submission Information: HealthSCOPE Benefits Claim Submission Information: HealthSCOPE Benefits PO Box 99006 Lubbock, TX 79490-9006 EDI Payor ID: 71063

ALERT! WHIRLPOOL HSB ID CARD 2017 CHANGES HealthSCOPE Benefits ALERT! WHIRLPOOL HSB ID CARD 2017 CHANGES New id cards will be issued for 2017. Whirlpool is changing PBM to MedImpact effective 1/1/17. Member id’s, claims submission provider networks are the same. The Aetna logo is for outside the local Lakeland area. Whirlpool is moving to 2 cards per family instead of a card with each dependent name. The card will indicate coverage status of EMPLOYEE only, EE and SPOUSE, FAMILY etc.

HealthSCOPE Benefits Whirlpool 2017 Benefit Plan Options

HealthSCOPE Benefits Whirlpool 2017 Biometric Screening Incentive Info

HealthSCOPE Benefits Whirlpool Prescription Drug Benefit 2017

PRE-CERTIFICATION PROCEDURES HealthSCOPE Benefits PRE-CERTIFICATION PROCEDURES All members, along with their providers, will be required to pre-certify all: Non-emergency inpatient admissions Major outpatient surgical procedures Non-stat MRI, PET and CT Scans Outpatient mental health facility admits or visits Dialysis Chemotherapy Contact HealthSCOPE Benefits for pre-certification at 1-800-660-212 Member ID card has reminder statement regarding pre-certification

PRE-CERTIFICATION PROCEDURES CLICK ON SUBMIT PRECERTIFICATION REQUEST Submit online precert requests:

PRE-CERTIFICATION PROCEDURES HealthSCOPE Benefits PRE-CERTIFICATION PROCEDURES Submit online precert requests:

HealthSCOPE Benefits Copy of provider EOB