Eligibility and Benefit Verification

 

SCAN offers three options to verify member eligibility and benefits:

SCAN’s Provider Portal

Providers can self-register at SCAN’s Provider Portal and follow the directions provided in the Portal Guide.

What information is available on the Portal’s Eligibility Tab?

Subscriber Information
Member Eligibility Confirmation
- Print or save Member Eligibility with confirmation date
- Confirmation serves as proof of verification
Member ID# and Enrollment Status
Member’s Address and Phone Number
Member’s Language Spoken/Written
Plan Type & Plan Name
Current Facility Group Name & Facility Group ID# (aka IPA# and Name)
Current PCP Name, Address, Phone# & PCP ID#
Address to Submit Claims

Coverage Information
Current Medical Benefit Effective Date & Term Date (if exists)
Current Other Supplement Benefits (i.e., Dental) Effective Date (if applicable)

Benefit Plan History
Benefit Plans ID#/Name, Effective Dates, and Termination Dates (if applicable)

PCP History
PCP #/Name, Facility Group #/Name, Start Dates & End Dates if applicable

View Members Current Benefit and Evidence of Coverage (EOC)
Click on Benefit Plan Grid (at top of page) to view the member’s plan benefits and co-payment details
Click on EOC to access Members plan details (at top of page)

How to view Member’s Eligibility on the Eligibility Tab
Two ways to search:
1. Member Last Name, First Name and Date of Birth or
2. Member ID# (must enter 9-digit number followed by “01” at end)

Note: Multiple members eligibility can be searched by entering a comma between each Member ID

For Portal Assistance
Email: ProviderPortal@scanhealthplan.com
Phone: (888) 450-7226, Mon-Fri, 8am-4pm PST

Electronic Eligibility and Benefit Inquiry & Response (EDI 270/271)

SCAN encourages Providers to utilize the 270/271 Eligibility and Benefit Inquiry and Response as it is the most efficient option to obtain SCAN member eligibility and benefits information.

Providers can contact their Clearinghouse (provide SCAN’s Payer ID# 10178) and Practice Management System (PMS) vendor or Hospital Information System (HIS) vendor to establish EDI 270/271 connectivity with SCAN.

SCAN Clearinghouse Information

SCAN EDI 270/271 Vendor: FinThrive (formerly TransUnion Health)

SCAN’s Payer ID#: 10178

SCAN’s Interactive Voice Response (IVR)

Providers can verify member eligibility and benefits and obtain a faxback via SCAN’s IVR. No registration is required. You can access SCAN’s IVR by calling 877-788-7226, available 24/7.

What Eligibility/Benefit information is available on IVR?

  • Member’s Enrollment Status
  • SCAN Effective Date and Termination Date (if one exists)
  • Medical Group Name and Effective Date
  • Medical Group Address and Phone Number
  • PCP Information: Name, Address, and Phone Number
  • Benefit Plan Name, Number and Effective Date and Termination Date (if one exists)
  • Copays: PCP, Specialist, ER, Hospital, DME, Lab, Other

What information is needed to access SCAN’s IVR?

  • Tax Identification Number (TIN) or National Provider Identifier (NPI) Number
  • Member Identification Number (Member ID#)
  • Member Date of Birth (DOB)
  • Fax Number (for Fax Back)
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