Check Eligibility
We recommend that you check member eligibility every time a member presents for services. Changes in health status, such as pregnancy or certain medical conditions, may also cause changes in plan eligibility.
| Important Tools & Resources | |
| Provider Portal | Member ID Card |
You can easily verify member eligibility by accessing the provider portal or through an eligible Electronic Data Interchange (EDI) clearinghouse. | The member ID card is used to identify a member; it does not guarantee eligibility or benefits coverage. |
Quick Tips: Member Consent
- When you check eligibility on the provider portal, you can also determine if a member has granted consent to share sensitive health information (SHI).
- When a member has a sensitive health diagnosis (e.g., treatment for drug/alcohol use, genetic testing, HIV/AIDS or sexually transmitted diseases), you should verify if the patient has granted consent to share health information. On the portal, a message displays on the Member Eligibility page if the member has not consented to sharing sensitive health information.