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Provider Portal Tools for Self-Service

As the Coronavirus (COVID-19) situation continues to develop, we maintain the health and wellness of the patients and communities as our top priority.

To assist you in caring for your patients, we offer a variety of several self-service resources within our secure provider portal. Our self-service channels are a helpful way to fight the Coronavirus (COVID-19). By using our Provider Portal instead of calling to speak with a live agent, you are allowing our live customer service teams to prioritize services for providers who are actively assisting our most critical members during the pandemic.

Through our self-service channels, you have access to a host of services within our Secure Provider Portal, including:

  • My Patients: Allows you to review a member’s eligibility, benefits, and their member profile. A comprehensive member profile includes a member’s address, contact information, co-pay, plan history, coordination of benefits information, pharmacy utilization and more.
  • Authorizations: Review authorization requirements, and submit and review authorization requests, including lookup of authorization status.
  • Referrals: Submit referrals by choosing either Consult and Treat or Consult Only.
  • Claims: Submit professional and institutional claims, search and view real-time claims status, as well as dispute, appeal, correct and void claims.
  • Appointment Agenda/Visit Checklist: View and print appointment agenda/visit checklists to quickly access the information you need to review and address with your patients.
  • Care Gaps: The portal identifies members with care needs that may have not been addressed and provides status on whether the member is compliant or non-compliant.
  • Care Management: Use the Care Management section of the portal to request a medical authorization, search authorizations, request a referral, search referrals, and search drug authorizations.
  • Reports: The secure provider portal offers a wealth of reporting data. View active member reports, inpatient log reports, pharmacy utilization reports, care needs reports, and emergency room reports.
  • Training: The resources section of the portal offers users training modules on topics such as Provider Orientation, Cultural Competency and more.
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Y0070_WCM_42183E Last Updated On: 3/20/2020