Some of your Independence patients may have received a new member ID card for coverage effective in 2020. It is important that providers confirm the member’s coverage and eligibility at each visit, prior to rendering services.
For our Independence and out-of-area Blue Plan members, providers should:
Medical Policy/PreCertification for out-of-area Blue Plan members
The Medical Policy/Precertification Router allows an Independence network provider access to information about the out-of-area Blue members Home Plan through NaviNet Open. For more detailed information about NaviNet Open and for access to our NaviNet Open transaction user guides, visit the NaviNet Open section.
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Make a copy. Make a copy of the member's current ID card to ensure that the most up-to-date information is submitted on the claim. Refer to the Quick guide to Blue member ID cards for information on the various ID cards that could be presented by out-of-area Blue Plan members.
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Verify eligibility and benefits. Verify eligibility and benefits on the NaviNet® web portal (NaviNet Open) through the Eligibility and Benefits Inquiry transaction. For out-of-area Blue Plan members, use the BlueExchange® Out of Area transaction.
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Complete COB, as applicable. For out-of-area Blue Plan members, have them complete the Coordination of Benefits (COB) Questionnaire for Out-of-Area Members, if applicable.
There may be occasions when a member’s health insurance goes into effect before receiving a member ID card in the mail. Or, a member may forget the card. If a member does not bring an ID card to an office visit, you have options:
- You may ask members to print a temporary ID card by logging on to our secure member portal available at ibx.com.
- You may access real time, detailed eligibility and benefits information for Independence members through NaviNet Open using the Eligibility and Benefits Inquiry transaction. There you will find information about a member’s demographics, insurance, and cost-sharing information (i.e., copayment, deductible, and coinsurance).
For your convenience, NaviNet Open and ibx.com are available seven days a week.
NaviNet® is a registered trademark of NantHealth, an independent company.