Network Status 1
If the Agent says "This provider is participating." the following benefits are collected.
What is In Network?
This is another term for non-participating.
What is OON or Out of Network.
The provider and address are listed on the BCBS website, but the specialty listed doesn’t match. This is the next prompt.
What is 'Does the patient have OON benefits?'
The provider is out of network. This is the next prompt.
What is 'What is the network status of the practice?'
A doctor or practice that agrees to accept a discounted rate for covered services.
What is INN or participating?
A provider’s name and specialty matches what is seen on the BCBS website, but the address listed doesn’t match.
What is 'In network Different Address'
If the agent doesn’t know the provider status and EBV is unavailable but the provider can be seen on the website(with matching specialty and address), this is the next prompt (BCBS).
What is “According the BCBS website, I am showing the provider listed. Can we please proceed with INN benefits?”
The provider is OON, and the practice is INN, but at a different address. These are the selections on the platform.
What is Out of Network for provider, and In Network for practice. Bonus Question! What is the TN?
An agent volunteers the provider’s network status before reaching that part of the script. It is a requirement to ask again later.
What is false. PIN the answer and select the correct option from the drop down.
If the agent doesn’t know the provider or practice status and the provider is not on the website, this is the next prompt (BCBS).
What is "Does the patient have out of network benefits?"
The Payor is not a BCBS Payor. They ask "Are you in network?"
What is "Can you check that please?"
This is the situation in which benefits for both in‑network and out‑of‑network must be collected.
What is, when the provider and practice are Unknown, and the patient has out of network benefits.
When an agent can’t provide a provider’s network status, this is the dropdown option to choose — followed by the prompt given next.
What is, Unknown and What is the network status of the practice?
Other than BCBS Payors, additional Payors can also be checked on the website.
What is false.
If the agent voluntarily mentions the provider's status as OON in a BCBS call and EBV/website information shows INN, the correct action is to follow the EBV/website result.
What is 'False'?