HealthSCOPE Benefits State of Nevada PEBP Provider Tool Kit

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1 HealthSCOPE Benefits State of Nevada PEBP Provider Tool Kit

2 Claims and Customer Care HealthSCOPE Benefits (HSB) is pleased to be the new medical, dental, vision HSA and HRA administrator for the State of Nevada Public Employees Benefit Program effective July 1, It is our goal to provide you with excellent customer care and ensure that you always have a positive experience with us. Some general information is included in this booklet to help you understand the PEBP benefits and how to contact us. Plan Changes Effective July 1, 2011: This booklet includes information about the 2012 benefit and instructions on how to file claims as well as how the debit card works. Customer Care: The Customer Care phone number for PEBP members is NEVADA ( ). Customer Care specialists are available Monday through Friday between the hours of 8am and 5pm Pacific Time. Customer Care specialists can help you with inquiries along with any claim or benefit questions. Many questions can be answered through our Interactive Voice Response (IVR) telephone system that is available 24 hours a day, 7 days a week, and 365 days a year. The IVR allows you to get plan design information as well as check eligibility, claim, and payment status. You may also log onto our website at to receive the same information.

3 HealthSCOPE Benefits Customer Care Tools Pre-certification/Pre-authorization Claim Status Eligibility Benefit Information Provider Network verification Copies of EOBs

4 Provider EOB

5 HealthSCOPE Benefits PEBP Provider Customer Care WebTools Click on Provider, View Eligibility/Benefits to check on: Claim Status Eligibility Benefit Information Precert Information Copies of EOBs Deductible/Out-of-Pocket Maximum Accumulation Status

6 HealthSCOPE Benefits PEBP Provider Customer Care WebTools Type in PEBP, Click Enter to check: Claim Status Eligibility Benefit Information Copies of EOBs Deductible/Out-of-Pocket Maximum Accumulation Status

7 HealthSCOPE Benefits PEBP Provider View of Accumulators

8 HealthSCOPE Benefits PEBP How the HSA/HRA Works and the Use of the Debit Card The 2012 plan year has begun, and members were provided with funds from PEBP in their HSA/HRA on July 1. Members can choose if they wish to use the funds in their HSA/HRA. If they choose to use their debit card for payment to you, please note the following: 1. We would prefer that you send the claim to HealthSCOPE Benefits and allow us to adjudicate the claim so that you know the exact amount that the member owes before you run their debit card transaction. 2. If you are unwilling to wait for reimbursement, please do not charge the member for more than the negotiated allowed amount with the PPO network. 3. If you charge the member more than the allowed amount, you will be expected to reimburse the member immediately. 4. Once HealthSCOPE Benefits has adjudicated the claim, you can bill the patient their patient responsibility, and the patient can provide their debit card number just like any other credit card transaction if they wish to pay the bill with their HSA/HRA funds. 5. Members may chose to pay you by check or other credit card. See below for an example of the HSA/HRA debit card:

9 HSA vs. HRA Health Savings Accounts (HSA) Health Reimbursement Arrangement (HRA) Who owns the funds in these accounts? Employee Plan Sponsor Who funds it? Is it portable? Can it rollover? Employer Federal Tax Advantages? Plan Sponsor / or Employee Yes Yes Plan Sponsor contributions are deductible as business expenses Plan Sponsor Generally not Yes (Plan Sponsor sets rules) Reimbursements are deductible as business expenses Employee federal tax advantages? Plan Sponsor contributions are not taxable to the employee Employee contributions are tax free Earnings are tax free Qualified withdrawals are tax free Plan Sponsor payments for reimbursements are not taxable income to the employee Employee claims against the account are tax free Are there health plan requirements? When are funds available? Must be accompanied by an HSAqualified high deductible health plan (HDHP) Immediately upon deposit No requirements, but generally accompanied by a high deductible health plan (HDHP) At discretion of Plan Sponsor Can interest accrue? Yes No Please note this document is general information regarding the workings of HSAs and HRAs

10 HealthSCOPE Benefits Claim Submission Tools Submit Medical, Dental and Vision claims to: HealthSCOPE Benefits P. O. Box Lubbock, TX EDI payer ID: