Allows for the viewing of Claims, Accumulator, Flex, and Cobra information.

  1. Viewing a Participant's Claims - Select a person by clicking on the folder icon to the left of the person's name. Claims, Accumulator, Flex, and Cobra selections will be made available after a person is selected.
  2. What Does the Lock Symbol Mean? - The family member is 18 years of age or older, and the member must allow access from their account to other family members. This is due to HIPAA (Health Insurance Portability and Accountability Act section 108). Other family members must sign up for their own account before being able to provide access to their information.

Claim List

All claims are shown in DOS order from newest to oldest.

  1. Searching Claims - Claims can be filtered by typing in search criteria below the respective column heading. Filtering will happen as the criteria is typed in. There is no need to click any additional buttons to perform the search.
    Filters can be cleared by removing the search criteria from the boxes.

    The DOS filter must be entered in YYYY-MM-DD format
    The Charges filter must omit the $ sign and must include the decimal even if there are no cents.

  2. Viewing a Claim - Click anywhere in the row of the claim to be viewed. This will pop up the claim detail screen.
  3. Paging - 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.

  • 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).

Claim Detail

The claim detail screen is valuable for seeing how your claim was submitted from your doctor, and how you claim is paid in accordance with your health plan.

  • Ask a Question - When clicked, a box will be presented to ask a question regarding the current claim being viewed. Enter the question into the “Type Your Question Below” text area. Click the “Ask” button to submit your question to customer service. The status of your question can be viewed at a later date under My Account > My Transactions in the main menu.
  • Insured EOB - When clicked, a new window will open displaying the actual EOB that was sent for this claim, or a replica EOB, if the original is not available online.
  • Plan Document - When clicked, a new window will open displaying the corresponding plan document.
  • Check Detail - Hover the mouse over the $ symbol next to the "Check" label (PAID claims only).  This will show the check details.
  • Service Line Detail - Hover the mouse over the ! symbol next to any detail line item (if present).  This will show the explanation of denied charges details.

 

 


Accumulators

  • Select the Year and Product to view the 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).


Cobra - Information regarding Cobra effective and payment dates are presented on this screen. This screen will show the message “This Participant is not on Cobra” if the person being viewed is active or not participating in Cobra.


Flex - You must select the year and account to view Flex accumulators.