Electronic Explanation of Benefits Now Offered via My Account

Transcription

1 For Distribution to Brokers/General Producers/Full-Service Producers Only (Not Intended for Distribution to Groups and Members) November 1, 2011 Electronic Explanation of Benefits Now Offered via My Account MARKET: GROUPS ON FACETS ONLY Currently, CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (collectively CareFirst) mail 1 to 2 million paper Explanation of Benefits (EOB) statements to members each month. In an effort to reduce paper and Go Green, members of groups on the Facets system can now access and print electronic EOBs by logging into My Account at Members who are currently registered for My Account and have provided their address to CareFirst will receive a notice regarding this new offering. Electronic EOBs have a new and improved format that will include claims that are processed over a weekly time period. While only claims with dates of service starting 11/4 will be available online, members can access their electronic EOBs for 3 years. After that time, Member Services will provide additional information. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered trademarks of the Blue Cross and Blue Shield Association. CareFirst is a registered trademark of CareFirst of Maryland, Inc.

2 Accessing Electronic EOBs Members who are registered users of My Account can log-in and visit the EOB section of the site under Manage My Plan. To receive weekly notifications when electronic EOBs are available, members should select Go Green on their claims detail page or update their preferences under My Profile. Members who are not registered for My Account can sign-up for electronic EOBs at by clicking Register Now to set-up a User ID and password. Account Flyer and FAQs Attached is a flyer about this new offering that you can share with your accounts that are on the Facets system. Also attached are that can be distributed at the employee level. Should you have any questions, please contact your Broker Sales Representative. Shekar Subramaniam Associate Vice President, Broker Sales CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered trademarks of the Blue Cross and Blue Shield Association. CareFirst is a registered trademark of CareFirst of Maryland, Inc.

3 Q: What is an Electronic Explanation of Benefits (E-EOB)? A: An Electronic Explanation of Benefits or E-EOB is a weekly summary of medical and dental claims that have been processed by CareFirst or CareFirst BlueChoice. E-EOBs will display details about claims processed for you, your spouse and/or dependents (if applicable). Q: How are E-EOBs different or better than paper EOBs? A: Only available in the My Account section of E-EOBs have been redesigned to help you easily understand the claims that are processed over a weekly time period. E-EOBs are available for you to view and print at your convenience. Q: How do I access an E-EOB? A: If you are a registered user of My Account, you can log-in and visit the EOB section of the site under Manage My Plan. Q: How do I sign up for E-EOBs? A: Visit and register for My Account, if you haven t already. Once online you can choose to receive weekly notifications about your E-EOBs. Q: How do I opt-in to receive paperless EOBs? A: Select Go Green on your claims detail page within My Account or update your preferences under My Profile. If you have not registered for My Account, visit Once online you can choose to receive weekly notifications about your E-EOBs. Q: Who can access my E-EOB? A: Only the registered subscriber can access E-EOBs through My Account. Page 1

4 Q: Is my family s information also included on my E-EOB? A: In some cases, there are confidentiality reasons why a family member s information is not available on your E-EOB. If there are no confidentiality reasons, as the subscriber, you can access all information for claims processed for you and your family by viewing, saving and/or printing a copy of the weekly E-EOB. Q: How often can I access an E-EOB? A: You can access an E-EOB on My Account as often as you like. Q: How long are E-EOBs available online? A: Once available, E-EOBs will be accessible online for as long as 3 years. Q: How do I access E- EOBs that are no longer available online (4-7 years old)? A: Select Contact Us or Communication Center in the top header of your My Account to send a secure to a CareFirst Customer Service Representative. You can also call the number on the back of your member ID card to obtain a copy of an E-EOB that is no longer available online. Q: Are there any EOBs that will not be available electronically? A: Yes. While E-EOBs will be available online in the fall of 2011, any E-EOBs created prior to November 2011 will not be included. Q: Is the E-EOB on hcbo.com different than the E-EOB on carefirst.com? A: Although the information in each E-EOB is very similar, the format and availability of EOBs on hcbo.com and carefirst.com may vary. Q: Will I still get paper EOBS? A: Once you sign up for E-EOB notifications, in most cases you will no longer receive paper EOBs mailed to your home via the U.S. Postal Service. Page 2

5 In the instance that your EOB includes a check made payable to you, the subscriber, you will also receive a paper EOB in the mail. If an alert is attempted and fails for one of a variety of reasons, you may begin to receive your EOBs via the U.S. Postal Service. Q: Can I stop getting E-EOBs and have them mailed to me instead? A: Yes. At any time you can visit My Account at to change your notification preference. If you choose not to receive notifications, you will begin to receive your EOBs via the U.S. Postal Service. Q: Why can t I find my E-EOB? A: E-EOBs are processed on a weekly basis for finalized claims. If a claim is still pending (not completely processed), it will not be displayed on your E- EOB. There may also be instances where a claim is listed as finalized in its status but no PDF is available. When this occurs, you should check back in a few days to view the E-EOB, as the system is updated once a week. Q: How do I get a paper EOB? A: You may contact Member Services at the telephone number listed on your member ID card to obtain a paper copy of an EOB. You can also print a copy of your E-EOB from My Account at Q: How can I compare claims that have been adjusted? A: You can compare claims that have been changed or adjusted by searching for claim numbers on the search claims detail screen in the Manage My Plan section of My Account. Q: How do I know if a claim has been overpaid by my insurance? A: Claims that been overpaid by your insurance will be documented on your E-EOB. A separate box will display the claim number, the original payment Page 3

6 amount, the adjustment or overpayment amount and the remaining balance. Q: What is a Remark Code? A: On your E-EOB there will be a column called REMARK CODE. A Remark Code is typically a 4-digit number that references a special note on the E- EOB. Q: Where can I find a Remark Code Explanation? A: The Remark Code Explanation is found at the bottom of your E-EOB after all claims have been listed. This explanation will note if an adjustment has been made. Q: What is a statistical adjustment? A: A statistical adjustment is a change to your claim that does not impact payments or dollars. Q: How do I know if a claim has had a statistical adjustment? A: This will be noted on your E-EOB through the use of a Remark Code. Q: What is an upward adjustment? A: An upward adjustment is a change to your claim that may or may not impact payment or dollars. It is a change to the claim that results in a positive result for the subscriber or member on that particular claim. Q: How do I know if a claim has had an upward adjustment? A: Upward adjustments will be noted on your E-EOB through the use of a Remark Code. Page 4

7 Q: Why is a claim missing from my E-EOB? A: If the claim doesn't appear in the list after searching, here are a few things to try: If your doctor submits your claim, and it has been less than 15 days since the date of service, check again in a few days. If it has been at least 15 days since the date of service, contact your doctor's office to make sure they submitted the claim. If you sent the claim yourself and it has been more than 15 days, double check your copy to make sure all of the information is correct (such as your member ID, group number, patient name, date of birth). If any information is incorrect, please send the claim again. If claims are still in pending status (not completely processed), please check back later to verify the claim is listed on your E-EOB once finalized. Select Contact Us in the top header of your My Account for information on how to receive additional assistance. Q: Who do I contact about my E-EOB? A: Select Contact Us or Communication Center in the top header of your My Account to send a secure to a CareFirst Customer Service Representative. You can also call the number on the back of your ID card. Q: How long will it take for a claim to appear on my E-EOB? A: Each claim is different and processing times will vary. How long it takes to process a claim depends on these factors: o How soon your doctor or hospital submits the claim. Almost 80 percent of claims are received within 30 days from the date of service. In some cases, it can take up to 60 days before your doctor or hospital submits a claim. o How quickly we process the claim once it s received. More than 90 percent of claims are processed within 7 days of receiving them. o Whether you have gone to an out-of-network doctor. If you have gone to a out-of-network doctor or hospital, two other factors may affect the length of time it takes to process your claim: Page 5

8 Whether the doctor or hospital requires partial or full payment at the time of service. Whether the doctor or hospital can bill us directly or you need to submit a medical claim form. Q: What types of services will be included on my E-EOB? A: You will be able to view claims for medical and dental services. Q: What is an appeal? A: An appeal is a timely request for a formal review of an adverse benefit decision, such as a claim denial or how we applied your deductible or coinsurance. An appeal may be submitted by you or your authorized representative. Q: How does the appeal process work? A: A first-level appeal is the first formal internal review of a claim decision. Under most plans, first-level appeals must be filed within 180 days of the date you received your EOB. A second-level appeal is a second formal internal review of that claim decision. Please check your health plan documents for the deadline to submit your appeal(s). On each level of appeal, a written response will be sent to you within the timeframe required by law. For plans that have two levels of appeal, a claim payment appeal is typically resolved within 30 days from the date we receive your appeal request. There is a limit to the number of times you may appeal a decision. The limits are described in your plan documents, and the response will let you know if there are additional steps you can take. In the event you have exhausted your levels of appeal, the response you receive will notify you to that effect. Page 6

9 Q: Why am I not getting notifications from My Account? A: Sometimes from a new sender will automatically go to your spam or junk mail folder. Members must verify their address and opt-in to receive electronic forms of communication. Go to My Profile to update your and consent to ensure you receive notifications. Q: What is a document number? A: The document number will be generated on each E-EOB so that it is searchable online. Page 7

10 New! Online Access to your Explanation of Benefits (EOB) Statements Members can now review CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. EOB Statements online. The new electronic EOBs are: Designed in a new, user-friendly format that is easier to understand Easily accessible Stored online for three years If you would like to sign up for electronic EOB statements, simply register with My Account. Visit and, under Log in to My Account, click the Register Now tab. Once registered, you can elect to receive weekly notifications for electronic EOBs. If you are already a registered user of My Account, you can opt-in to receive electronic EOBs by either selecting Go Green on the claims detail page, or by updating your preferences under My Profile. In most cases, once you sign up for electronic EOB notifications, you will no longer receive EOBs mailed to your home. In the event that your EOB contains a check, you will receive the EOB via U.S. Postal Service. Remember: You can start or stop electronic EOB notifications at any time by simply logging in to My Account and changing your preferences. CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are both independent licensees of the Blue Cross and Blue Shield Association. Registered trademark of the Blue Cross and Blue Shield Association. Registered trademark of CareFirst of Maryland, Inc STF3593 (10/11)