What are Additional Benefit Provisions?

Health Plans: 

  • Highmark Blue Cross Blue Shield,
  • Highmark Blue Cross Blue Shield Delaware,
  • Highmark Blue Shield,
  • Highmark Blue Cross Blue Shield West Virginia

Workflow: 

  • General

If you can't find the benefit details that you’re looking for on the main Eligibility and Benefits details screen, click Additional Benefit Provisions

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When you click Additional Benefit Provisions, a pop-up window opens and displays additional benefits. 

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If the patient’s coverage includes multiple lines of business, multiple columns appear. Additional benefits vary based on line of business. 

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Select a benefit link to display the benefit details.

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Viewing Co-Insurance Amounts 

When you click a benefit type on the Open E&B details screen, you see the co-insurance represented as the percentage of the member responsibility (it is labeled as Individual).

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When you click a benefit type in the Additional Benefit Provisions screen, you see the co-insurance represented as the percentage of the health plan responsibility (it is labeled as Insurer). 

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Instead of seeing the 10% that the patient is responsible for, it displays the 90%. This is what the health plan is billed. 

Keep this in mind when billing a patient to ensure you are billing for what the patient is responsible for, and not what the health plan is responsible for. 

 

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