@YourService Tutorial - Members Claims - uhc logos

Khenderson

Informations

• Publié par: Phawying
• Nombre de lectures: 44
• Langue: English

Extrait

@ YourService Tutorial – Members & Claims

Your online provider center for HPN/SHL member plan information.




Table of Contents


Topic Page
Logging on 1-4
Member Search 5-6
Eligibility/Benefits 7-8
Claims Search 9
ClaHistory 10
Printer/Monitor Set-up Guidelines 11-12
Helpful Hints Additional Information 13
















1Logging on

Accessing @YourService is as simple as 1,2,3:

1. Start up your web browser. Note: @Your Service works with version 4.0 or later of either
Microsoft Internet Explorer or Netscape Navigator.

2. Enter the following URLs (web site address) for HPN www.healthplanofnevada.com for SHL
www.sierrahealth.com



This will take you to HPN’s home page. Be sure to bookmark this site for easy access in the
future. Note: if accessing SHL’s home page the screen will indicate Sierra Health & Life



Note: To bookmark, select Favorites then select Add.




3. To access @Your Service move your cursor over the words HPN @YourService located on
the left side of the screen. Note: If logging onto the SHL web site, the display will indicate
SHL @YourService.
2
The @YourService application will now begin in a new window
The left side of the screen has the Log in dialog boxes and the right side contains a disclaimer.

Enter the username and password that have been provided in the appropriate fields. Note:
Using the Tab key will move the cursor between the fields.


After the username and password have been entered, click log on. A security check will verify if
the information has been entered correctly.
3
Once the information has been verified, the Application Rules of Use will appear


Read the Rules of Use (scroll down using the arrows to see the complete text). Once the Rules
of Use have been read, click on Accept to proceed to the @YourService functions.
From the Main Menu you can search for a member or claim by selecting the applicable
search box. You can also submit and search prior authorizations.


4Main Menu – Member Search



Member Search
This screen allows you to access individual members. Information about individual members that
you can access includes, but is not limited to the following:

• Eligibility (Includes basic medical benefit coverage)
• Other benefits including vision and dental
• Pharmacy Benefits
• Prior Authorization status
• Claim status
Members can be found by performing various lookups. Partial Last Name, Partial First Name,
Last Name and DOB, Member Number, and Partial Last Name & DOB. For the best possible
search it is recommended that you complete as many fields as possible.
5

Note: The As of Date will default to the current date. If you are looking for historical
data, you will need to change the date. If a member terminated prior to the current date
defaulted, the member will not display.



If the member information you entered results in no members being found, a message appears at
the bottom of the screen indicating, “Your search produced no results. Click the back button to
search again.”
6Member Search – Eligibility/Benefits
Once a member is found the following information is returned. Select the appropriate row to be
viewed by clicking on the member id number.



The member eligibility Screen will now display.




The member eligibility screen contains links to the following information (depending on their plan):
• Medical Benefits
• Dental Benefits
• Pharmacy Benefits
• Vision Benefits
* Health Record is an option for accessing medical information (only if the member has chosen to have
their information available).



To view a members benefit information simply click on the link to the applicable
benefit you wish to review.
7
When displaying a member’s medical benefit information the following screen will appear
displaying a list of the top 22 most common copays for services rendered.



This screen also provides valuable information such as:
• Effective Date
• Termination Date if applicable
• PCP Information
• OB/BYN PCP Information for female members
• Benefit Code & Benefit Group description
• Links to additional information such as Claim history, Prior Authorization information,
Deductible/Accumulator information, Other Insurance Information, an online Reference Center
and Utilization Management Protocols & Criteria.

If you wish to review a member’s pharmacy, vision or dental benefit information, click the back
button to select a new benefit category.
8
Main Menu – Claim Search

From the Main menu, select Claim Search.


This search option allows you to search for a specific
claim by member or for multiple claims by using a range of dates.

Note: Select the Calendar Icons to enter a date range


You can search for claims using the following criteria:
• From & To Dates of Service-Required Field
(format mm/dd/yyyy)
• Status-Required Field
• Member Number • Claim ID Number
• Member’s Last Name • Member’s First Name
9Member Search – Claims History

When selecting the claim history link a list of current claims will display for the member.

For detailed claim information click on the claim number you wish to review. The following claim
details will display:
• Claim #
• Dates of Service
• Provider
• Billed Amount • Patient Account Number
• Status • Processed Date if applicable
• Check # for paid claims • Check cashed date if applicable
• Patient Responsibility (The member’s copay,
deductible or coinsurance combined)
• Paid Amount. This is the amount paid on the claim.
This amount is equal to the Billed Amount minus contract
savings, Disallowed Amount, Risk Withhold, COB
Amount and Applied to Pre-Pay.




Note: If you are a specialist or a facility, you will only see the claims or authorizations that your office has
submitted for the period covered by the search. PCP offices will see all claims for the member. However,
capitated services (claims) will not be displayed.
10