Now you can quickly and easily review your participants' claims online with the click of a button! Blue Cross of Northeastern Pennsylvania's claims administration portal (CAP) is an easy-to-use, convenient tool that allows self-funded group administrators the ability to view participants' claims online. Eliminate time spent on the phone with customer service or your group benefits administration (GBA) representative!
Contact your sales professional today to register for CAPS if you have not already done so. He or she will send you a link to get started. Refer to the instructions below for some helpful information.
1. Pay particular attention to the username and password that you select.
- First Name*—First name of group designee who is signing on.
- Last Name*—Last name of group designee who is signing on.
- Date of Birth*—Group designee's date of birth.
- Group Number*—The group designee can input any one of the group numbers; this number will also provide access to all groups that have the same group leader and company code. Group number must be entered as nine positions, i.e., 0#####000. Do not enter dash (-).
- Company Number*—This is currently indicated on all group bills in the top right-hand corner.
- Group Admin Name*—This is currently indicated on all group bills on the left-hand side as "Group Leader."
- Username*—Must be at least five characters in length, with no spaces. (Please keep; you will need this for future use of the portal.)
- Email Address*
- Password*—Must be at least six characters in length, with at least one number and one letter. (Please keep; you will need this for future use of the portal.)
- Confirm Password*—Re-enter password.
- Secret Question*—Please select a secret question. The secret question and answer will be used to help verify your identity if you ever forget your username and/or password.
- Answer to Question*—Please answer your secret question.
- * Denotes a required field.
2. After you are notified via email that you have successfully completed the registration form, please contact your sales professional to complete your registration. Once activated, you can logon with the username and password that you created when registering.
3. When you want to access the Claims Administration Portal, just enter your username and password to begin.
- You will see a drop-down menu of your group numbers. Click on the group number you wish to view, which will take you to the group inquiry page.
- Once on the group inquiry page, you will see a listing of all participants in that particular group. Click on the unique member identifier (UMI #) of the participant. This will take you to the contract summary page, where all UMI #s of both subscribers and dependents will appear.
- Select the UMI # of the participant's claims you want to view.
- You will see the participant's information and list of claims on the Claims Detail page.
- Note: Only claims that occurred within the last six months will be displayed. If you are looking for claims that occurred before six months ago, you will need to do a claim search by claim number or by date range.
- Under claims financial information, you will see the member's cost, total charges and what was covered and not covered. Under service information you will see the service (procedure code), service date, total charges, payment and the status of the claim.
Key terms—following are some important terms and definitions to help you better understand the portal:
Member Cost—The amount for the incurred services.
Total Charge—The amount the provider charged for the service.
Payment Amount— The amount paid by the health plan.
Deductible Amount—A specified dollar amount of covered services, that must be incurred by an insured before First Priority Life will assume any liability for all or part of the remaining covered medical expenses.
Coinsurance Amount—A specific percentage amount of the allowable charge for which the insured is responsible after the deduction of a deductible or copayment, if applicable.
Amount Approved —The amount your coverage will pay for a service. This is the amount from which the insured's coinsurance or out-of-pocket costs, if any, will be calculated.
Penalty Amount—Except for medical emergencies or maternity admissions, if the insured does not obtain precertification from a non-preferred provider as required; the insured will be liable for payment of a penalty up to the first $500 of charges for the covered services, even though the services were medically necessary.
Copayment Amount—The amount, if any, an insured must pay directly to providers for covered services.
Eligible Amount—The amount your coverage will pay for a service.
Non-Covered Amount—The amount, if any, that is not covered under your plan, or the amount that is above the allowed charge for services.
Service Code—The number assigned to the service performed.
Units—The number of services that were performed on the date of service.
Status/Reason Code—An explanation of the benefits and/or services provided.
Frequently Asked Questions
What if I have problems registering or have any questions?
If you weren't able to register, please call our Information Technology Help Desk at 570-200-3600, weekdays from 8 a.m. to 5 p.m.
Do passwords expire?
The passwords do not expire; however, the accounts become inactive after 12 months of nonuse.
What if I forget my password?
If you forget your password, all you need to do is go to the Login Page and click "Forgot Password." You will be asked to enter the answer to your secret question.
If a group administrator changes, does his/her access get revoked? Can he/she still use his/her password?
There is a check in the system to see if the group leader is still active on our main system. If he/she is not still active, that designee is locked from viewing any information and cannot unlock the account without calling a sales professional. He/she cannot use the "Reset Locked Account" process, because this is locked in a different way.
Is the group administrator name case sensitive?