1. CA Public Health Billing Workgroup
February 26, 2013
Private Health Plans: Part 2

2. Agenda Welcome/ Introductions Private Health Plans: Part 2
Blue Cross
Enrollment Checklist
Online Verification
Cigna
Updates
Question and answer
Workgroup Schedule
Workgroup Contact info

3. Presenters
Robyn Davis, MPH State Coordinator, CA PH Billing Project Athina Kinsley, CMBS-I Health Insurance Specialist, CA PH Billing Project Timi Granados, BA Billing Project Coordinator, CA PH Billing Project

4. Out-of-Network Benefits
In-Network Benefits
Why does it matter if we are “in-network”?
Health Plans vary with coverage
Deductibles – met or not met
Co-insurance – what % is the patient responsible for
In-Network Benefits
Reimbursement Rate
Out-of-Network Benefits

5. Online Vs. Calling Online Calling Pros Pros Cons Cons Faster
Download document or print and scan
Cons
Out-of-network may not be clear
Deductible met or not met may not be listed
Pros
Out of network information
Deductible met or not met
C.S. Representative answer questions you may have
Cons
Timeliness

6. Understand a PPO card
PPO (Preferred Provider Organization)

7. Blue Cross

8. Blue Cross Enrollment Checklist
Developed to assist LHD’s initiate a BC contract
Complete Checklist and fax to:
(PPO)
(State programs)
Specialty
Lines of business
Healthy Families update

9. Select “California” and click enter
Online verification
Go to:
Select “California” and click enter

10. Online Verification (cont.)
Select “Medical” from the drop down menu

11. Online Verification (cont.)
Individual User ID
Individual Password
Contact System Administrator

12. Online Verification (cont.)
Enter member ID

13. Online Verification (cont.)
Select Subscriber or Dependent
Enter Service Date

14. Online Verification (cont.)
Select the Service type from the drop down menu
Ex: immunizations, well child, LAB, Family Planning etc.

15. Online Verification (cont.)
Select “View Eligibility & Benefits Details” from the “Action” drop down menu

16. Online Verification (cont.)
Print & scan or save

17. Online Verification (cont.)
This example shows Laboratory coverage as unknown. In this case, call the insurance to get benefits.

18. Cigna Updates
Contact Donna Dojan
(860)
Progress

19. Workgroup Schedule 3/26 2:00 PM – Third Party Administrators
4/30 2:00 PM – TBD
5/28 2:00 PM - TBD
6/25 2:00 PM - TBD

20. Contact Information
CA Public Health Billing Team
Toll Free (877)