Provider

Provider Information Group Plan SolutionsGroup Plan Solutions understands there are many different carriers that you work with in regard to claim processing.

Using our online tools below, you can verify necessary PPO status and pre-approval/prior authorization information. Detailed information concerning claim status, coverage policies, and more is just a simple click away.

Please don’t hesitate to contact a Group Plan Solutions representative for assistance with any claim filing questions you might have. Call
888-301-0747 or email.



Benefits

Click the link below for online benefit access.

File a Claim

To help expedite your claim, it is always best to file based on the information provided on the back of your patient’s ID card. Not all claims for members of GPS are filed to the same address. Not filing according to the unique instructions on each individual patient’s ID card could result in delayed claim handling.

Please contact GPS for filing assistance at 888-301-0747.

Claim Status

We want to give you immediate access to your patient’s Group Plan Solutions claim history to assist with simplifying the insurance process for our members.

To access your patient’s claims through WEBeci, you will need to have an account created for your office. Once you reach the login screen, by clicking the WEBeci link, you will see a Provider Access Request at the bottom of the screen. You will be notified once your account is activated.

WEBeci allows you to review online a patient’s claim history, check the
real-time status of a claim, obtain all the same information you would find on an EOB, as well as confirm eligibility.

Feel free to contact the Claim Department with any questions you may have at 888-301-0747 or email.

*GPS has contracted with Eldorado Computing, Inc., to provide WEBeci access.

Verify PPO Status

We want our members to get the most from their employers’ health plans. Choosing the correct in-network provider will help them get the highest level of benefit and you the highest level of reimbursement under the plan.


COVERAGE POLICIES

Description of Service

When a service involves multiple surgical procedures by the same professional provider, in the same setting, and on the same date of service, surgery reduction guidelines will apply.

Reimbursement Policy

Multiple surgical procedures (modifier 51): Procedures performed during the same operative session by the same provider are reimbursed at 100% of the regular, reasonable, and customary amount for the primary or first surgical procedure and 50% of the regular, reasonable, and customary amount for each secondary procedure.

Bilateral procedures (modifier 50): Procedures performed on both sides of the body during the same operative session are reimbursed at 100% of the regular, reasonable, and customary amount of the first surgical procedure and 50% of the regular, reasonable, and customary amount of the secondary procedure.

Exclusions: The above policy will not apply to procedures which are modifier 51 exempt based on AMA CPT Guidelines. The policy does not apply to procedures determined to be not medically necessary.

The following payment policies apply to medically necessary anesthesia services rendered by in-network or out-of-network providers. The eligibility of benefits for anesthesia services is based on the specific plan provisions or exclusions. Anesthesia services are normally covered when rendered in conjunction with covered surgical procedures.

Description of Service

Anesthesia is the administration of a drug or anesthetic agent by an Anesthesiologist, Certified Registered Nurse Anesthetist, or an Anesthesia Assistant for medical or surgical purposes to obtain muscular relaxation or to induce partial or total loss of sensation to a surgical site or to obtain total loss of consciousness.

Billing and Reimbursement

Anesthesia services can be billed using the following AMA Current Procedural Terminology.

• Anesthesia Services (CPT Codes 00100 – 01999)
• Moderate (Conscious) Sedation (CPT Codes 99143 – 99150)
• Anesthesia add on codes are reported in addition to their primary anesthesia code.

Services rendered by out-of-network providers will be reimbursed using the following relative value calculation.

• Base Units + (Time Units X Conversion Factor) = Regular, Reasonable & Customary Allowance.

Supervision of a CRNA by an anesthesiologist will only be considered for reimbursement if the modifiers of QK or QY are appropriately appended to the billed anesthesia procedure. Services billed by the CRNA must include the appropriate modifier of QX or QZ. When services are billed by both the anesthesiologist and the CRNA, for the same anesthetic service, reimbursement will be split (50%-50%) between the supervising anesthesiologist and the CRNA.

General Information

Pekin Life Insurance Company reimburses medically necessary services, provided in the most cost effective setting for the services needed. All policy language for coverage applies.

Benefit Information

General benefit information may be verified by faxing a request to 1-309-346-8265. The information will be returned by fax within twenty four (24) working hours.

Insured’s Responsibility

An insured may be liable for any of the following:

• Deductible
• Co-insurance
• Copayment
• Usual & Customary disallowed amounts
• Non-covered services