Page History

Last Updated v12.1.0v1

This screen is used to

view network claim information.

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Viewing a Participant's Information - Enter information into at least one of the search fields just below the column headings (DOB must be used in combination with another search field). Press ENTER to click the SEARCH. Click on the row containing the participant's information to view their claims and coverage information.

• Searching Claims - Claims can be filtered by typing in search criteria in the left Claim Search panel.
  • Click the Search button to execute the search process.
  • Once claim results are shown in the results list, the options listed below are available.

• • If the search criteria entered is too broad, the system

Claims

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• • may take excessive time to return results.  For the best results, please enter as much search criteria as possible.
  • **The results table contains multiple columns and can be scrolled right/left using the scrollbar at the bottom of the results to see more columns.
• Questions - Use this option to ask questions or fill out forms related to a claim in the result list.  Claim(s) in the result list need to be selected by clicking the checkbox in the "ASK" column of the results row.
  • **This option is NOT available in the Admin Center

• • .
• Export to Excel - Use this option to export all claims currently listed in the grid to an Excel sheet (includes all pages in the grid).

Back buttonImage Removed - Go back to the member list.

• Paging - Claims in the grid are shown 10 at a time. The bottom of the grid contains the current page being viewed and the total number of pages. The page can be changed by using the forward or back arrows. A page number can also be typed into the current page number box followed by the enter key. The grid will then jump to the given page number.
• View Image Added- The View button provides a selection of claim related documents like Claim Forms and Repricing Sheets.
  • Select an option from the list to view the corresponding document (Not all documents are available for all claims).  

Viewing Claim Details

Click anywhere in the Search Results row of the claim to be viewed. This will open the claim detail screen.

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• View - The View button provides a selection of claim related documents like Claim Forms and Repricing Sheets.
  • Select an option from the list to view the corresponding document (Not all documents are available for all claims).  
• How To Read Repricing Sheet - Click this button to view a help document related the contents of a repricing sheet.

Claim Detail Window

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• The claim detail screen shows demographic, check, EOB, and service line information about the claim.
• The TPA Center version of this claim detail view shows the provider's Tax ID and NPI fields (if available from the claim system.)  These fields do not show on any other Center.
• Click the EOB or Plan Document buttons to view those items in a new window.

Coverage

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• The coverage tab shows demographic, coverage, and plan information.
• Click on any Product or Covered Dependent row to see more detail about that record.

• Products - This area shows all covered products and details for the employee.  Select any product row to see the history of coverage for that product.

  • Image RemovedSelect the "View Plan" icon next to each product to display the related plan document.
  • Image RemovedSelect the "View Amendments" icon (if applicable) next to each product to display any available plan amendments or secondary documents.
• Temp ID Card (if available for the employer):  Click this option to see a PDF copy of the member's ID card.
  • Email Card:  Once the ID card is visible on screen, click the EMAIL CARD button to send a PDF copy of the ID card to a specified email address.

Ded/Plan Max

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• Select the Year and Product to view the deductible, out of pocket, plan maximum and other accumulator information.
• Web eXchange shows accumulators for years the participant has coverage.
• Click the Plan Document icon to view the related Plan Document (if available).

HRA (Conditional)

***The HRA tab is only available for certain employer groups that have custom HRA information stored on the HealthSmart core claim system.  Web eXchange does not show HRA information from third party vendor systems.  The HRA tab will not display if the member does not have any HRA amounts accumulated in the core claim system.

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• Select the Year to view the related HRA information.

COB (Conditional)

***The COB tab is only available for certain employer groups that have custom COB information stored on the HealthSmart core claim system.  Web eXchange does not show COB information from third party vendor systems.  The COB tab will not display if the member does not have any COB information in the core claim system.

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Transactions

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• Any Transactions for this member will be displayed in the grid list.  Filter the list as needed, and select any transaction to view the details.

Notes

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• Any Web eXchange related notes will be displayed on this tab.  Notes are only visible in the TPA Center.
  
• To add a new note, enter the note text in the box, then click the Image Removed button.
• The Image Removed button will send a copy of the notes to a PDF file to save or print.