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Who is HealthComp and Blue Shield? HealthComp is a third-party administrator that conducts the processing of claims, maintaining the group’s eligibility and benefit information associated with their plan.Blue Shield is the provider network that allows the group to utilize Blue Shield’s discounted rates for facilities and providers who contract with them.All Subscribers/Family MembersWho to call for eligibility, benefits, provider search, and claims information?For members, providers and facilities, all calls for eligibility, benefits and claims information should always go directly to HealthComp. If you are trying to locate a provider that is in the Blue Shield network, you would also contact HealthComp. When calling HealthComp, you will be prompted to enter your member ID number located on yourID card. Be sure to enter the number on the keypad that correspond to the letter in the ID number. You will automatically be routed to the customer service team.• HealthComp Eligibility, Benefits, Provider Search and Claims questions (800) 442-7247HCOnlineThrough Healthcomp, you also have access to your health benefits platform, HCOnline. 1. Go to HCOnline.HealthComp.com to experience a streamlined healthcare benefits portal.
How to search for providers: You can easily find and access healthcare providers through the Blue Shield website by following these simple steps:1. Go to the Blue Shield website (https://www.BlueShieldCa.com/Fad/Home).2. Press continue when searching for a provider out-of-state.• When seeking a provider in California, enter the location, plan, doctor's name, or specialty, and proceed with the search.3. Press “Find Care”.4. To get started with your provider search type in your three-letter prefix, which is “RXT”.5. Now, you can begin searching for your provider. If you prefer to speak to representative, please call HealthComp Eligibility, Benefits, Provider Search, and Claims questions (800) 442-7247.
Processing Claims:Who do providers submit claims to? Blue ShieldAll medical claims need to be submitted directly to Blue Shield. This will allow Blue Shield to apply the discounted rate. Claims are then forwarded to HealthComp by Blue Shield to apply the applicable benefit percentage, copays, and deductibles.NON-CA (in/out of network):General provider customer service line (800) 810-2583, option 2. This line will be able to help the provider get the contact information for the local plan if they do not have it readily available. If the provider already has the local plan’s information, we are advising that the provider outreach directly for quicker resolution on inquiries.CALIFORNIA (in/out of network)Phone: (800) 541-6652, option 2Mail: Blue Shield of CaliforniaP.O. Box 272540Chico, CA 95927-2540Providers may also engage support by registering for Provider Connection: • Login – Welcome to Provider Connection | Blue Shield of CA Provider (BlueShieldCa.com).• Chat is a feature available for providers via Provider Connection.For inquiries about claims, members can contact the Member Service team at (800) 442-7247.
Members, Providers and Facilities Who to call for Rx/Prescription questions?All members, providers and facilities call for prescription information always go directly to OptumRX. This information is located on your ID card. Please have your card available when calling so you can provide them with your ID and plan information.• OptumRX questions (855) 524-0381. Who to call for Pre-authorization information?All members, providers and facility calls should always go directly to Blue Shield. • Blue Shield Pre-authorization questions (800) 541-6652.Understanding your ID card:A. Your medical network is Blue Cross Blue Shield.B. Your Member ID is a unique number for you and your enrolled dependent(s).C. Your Group ID connects you with Real Chemistry.D. Your pharmacy enters this information, along with your Member ID, to process your medications.Your provider can verify your eligibility& benefits with HealthComp three ways:1. Register for your HCOnline account at HCOnline.HealthComp.com. Once you have registered and your account has been verified by HealthComp, you can log in to HCOnline and visit the home page to access eligibility and benefits.2. 24/7 Automated Fax System. Utilizing the provider number on the back of your ID card: press 1 for eligibility & benefits & press 2 for claim status.3. Call HealthComp's dedicated Member Service team at the number on your ID card. John SmithRXTC12345678ABCDDownload the HCOnline app or visit our website HCOnline.com