Heritage strives for the highest possible accuracy of the health plan’s membership through the use of standard processes and procedures in accordance with CMS guidelines. We strive to resolve any eligibility discrepancies in a timely manner to ensure every enrollee receives access to the quality health coverage they deserve. In dealing with health plan membership records, Heritage always follows the privacy guidelines for Personal Health Information (PHI) as established by the Health Insurance Portability and Accountability Act (HIPAA). From the time an Enrollment Application is submitted, Heritage knows the eligibility status of each member. We provide current eligibility information to our providers in several ways. First, Heritage's Customer Service Department is dedicated to provider inquiries, including eligibility status and benefits, and is open from 8:00 AM – 5:00 PM CST. Secondly, we offer 24/7 access to eligibility information via our web-based provider information service, MC-NET. Coming in 2006, providers will also have 24/7 access to current membership records via a toll-free phone call to our automated provider information line. |
