Frequently Asked Questions
How can providers get claim status and/or the first processed Explanations of Benefits (EOB) without contacting the Home Plan?
The status of a claim can be obtained by using My Insurance ManagerSM available on our website. Keep in mind that you should check the claims’ status prior to refiling, as refiling within 30 days of the previously submitted claim may not allow the Home Plan enough time to process the initial claim. .
What is the difference between Home Plan and the Host Plan?
Both the Home Plan and Host Plan have their own set of responsibilities and they are outlined below.
Home Plan (for the member)
- Adjudicate claims based on member eligibility and contractual benefits
- Utilization review (prior authorization)
- Member inquiries and education
- Sends member the EOB
Host Plan (for the provider)
- Point of contact for claims inquiries and education
- Forwards clean claims to the Home Plan for processing
- Applies pricing and reimbursement to claims
- Sends provider remittances
How should medical record requests be handled?
Providers may receive requests for medical records as needed for claims-related purposes, such as to determine the medical necessity of a service. If a claim has pending medical records, please be sure to submit them as soon as possible to avoid delays in the processing of the claim.