Provider Portal

Eligibility
Claims
Copay

Claims

Fields marked with * are required.

Benefit Type*

Select Benefit Type.

Subscriber SSN or Card ID*

Subscriber SSN is required.

Only numbers, alphabets, and '-' are allowed.

Patient Gender*

Male

Female

Patient Gender is required.

Patient Date of Birth*

Patient Date of Birth is required.

Please use MM/DD/YYYY format.

Please enter a valid date.

Provider TIN or SSN*(used in billing)

Provider TIN or SSN is required.

Only numbers are allowed.

Enter a valid 9-digit number.

Patient First Name

Only numbers, alphabets, dot, '-' and apostrophe are allowed.

Subscriber Group #

Subscriber Group # is required.

Only numbers, alphabets, and '-' are allowed.

Claim Start Date of Service*

Claim Start Date of Service is required.

Please use MM/DD/YYYY format.

Please enter a valid date.

Claim End Date of Service*

Claim End Date of Service is required.

Please use MM/DD/YYYY format.

Please enter a valid date.

Claim End Date of Service must be on or after the Claim Start Date of Service.

Verification Required.

Copay

Fields marked with * are required.

National Provider Identifier (NPI)*

Enter a valid 10-digit NPI number.

Procedure Code Type*

Procedure code type is required.

Procedure Code*

Procedure Code is required.

Date of Service*

Date of Service is required (MM/DD/YYYY).

In Progress

Name	Date Created	Details

In Progress With Other Collaborator

Name	Date Created	Details

Completed

Name	Date Created	Details

Details

Task

Add New Activity

Fields marked with * are required.

Select Activity Type *

Provider Portal Disclaimer

This is a summary of member eligibility and/or claim status. The information provided is current as of the date and time of inquiry. We do not assume any obligation to notify you of any changes in eligibility. Not every service or charge is covered under a plan, and this is not a guarantee of payment or a final determination of current eligibility.

Actual benefits are subject to all plan terms, definitions, limitations, and exclusions that are in effect on the date of service, including any limitations or exclusions related to preexisting conditions, medical necessity, or usual and reasonable charges. Changes in status, like employment, marital status, disability, or student status that may be known to the subscriber and/or member may not be reflected here at the time of inquiry, though the latest information we have is shown.

Artificial Intelligence (AI) Notice: This portal uses AI-assisted tools to help surface and summarize information. AI-generated results are provided for informational purposes only and may not be complete, current, or free from error. AI outputs do not constitute a guarantee of benefits, a determination of medical necessity, or a final adjudication of any claim. All AI-generated content should be independently verified against authoritative plan documents, eligibility records, and applicable payer policies before making clinical or administrative decisions.

AI tools may produce inaccurate, incomplete, or misleading results. Do not rely solely on AI-generated summaries for treatment authorization, billing determinations, or patient care decisions. Human review by qualified personnel is strongly recommended for all consequential decisions. We expressly disclaim any liability arising from reliance on AI-generated information provided through this portal.

By clicking "I Agree" below, you acknowledge that you have read and understand this disclaimer, including the AI Notice above, and agree to use the Provider Portal information subject to these terms.

Where do I find my Member ID?

Health Plan ID Card (9 character identifier starting with T, H, 9, or 0)
Health Plan ID Card (12 character identifier starting with D2 or D3)