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1. Step 4 Other Coverage This is the final screen in the new enrollment process Indicate Yes or No by clicking the corresponding circle Q Clicking No to this question will automatically activate No in the corresponding check boxes below Clicking Yes to this question prompts you to complete the necessary information below which is used to populate the pre existing field e Enter the appropriate begin and end date for each member who had prior coverage If no prior coverage information is provided enter the hire date as the prior coverage begin date and leave the end date blank This does not apply if you are processing in the Open Enrollment mode or if the employee has chosen an HMO plan if you enter begin and end dates then check Show Total Months EmployerAccess automatically calculates and displays the total number of months Note Pre existing data cannot be changed in EmployerAccess after a member has been added o This is the last step in the enrollment process Click Continue to complete the new enrollment 441 4 athan OSORA Get 2 Ue T0 nt Serer EmployerAccess Visico JOMN SATH armin Finter h Blog os thrin tap Member Intormaben Setect Cover aue Astean Cuver age Other Coverage Subrcriter Marne JUN SRT Orap Name AIC COMPANY Member O 417345678 OmvupNumber GATZ345 Other Covet age 1 Does any member Beng aided have oer coverage O ves O No 2 Does
2. f everything looks right Dependent Ute Indicates a Required Field click Continue Step 3a Assign Coverage The following screen appears if provider information is required i e for HMO medical plan A Enrolls subscriber and all dependents in selected coverage B Enrolls subscriber and all dependents with the same medical Primary Care Physician PCP C Indicates that all members are existing patients of the medical PCP D Allows the system to pick a medical PCP for all members A Indicates that the individual family member is an existing patient of the selected PCP B Allows the system to pick a medical PCP for each individual family member vone JONN SMITH Brow Bhe Boo ES A D Erect ail members in coverage selected B O Sume medical PCP ID for ap members OrPo Provider Finger CO exiting patent Aut 9 D JOHN SMITH Suusinber Mee 01 01 1970 OFCPID O Beating patient DO Auv Pirk PCP ID JANE SMITH Spouse Female 02021971 05 01 2006 JEBSE SMITH Chad Main 02032000 05012005 OfcCPID Lu O Exstng patent O Aut Pick PCP ID DENTAL NLT 2000 SEPS NUS 1900001 me JOHN SMITH Subscnber Mee 9101 1970 US 01 2006 F JUNE SMITH Spouse Female 202 1971 05 01 2006 n JESSE SMITH Chid Mule 03 03 2000 06 01 2006 tm Lite Coverage Sutrecriber Life 05 01 2006 Depeedunt Life 04mt1 006 a beficates a Required Fios
3. 15 450 45 Amount Due Sutunit Self Bil Life Worksheet Pay 20 345 45 Self Billed Amount 20 345 15 Total Amount Dua Frequently Asked Questions Can there be more than one administrator in a group who can process eligibility on EmployerAccess e Yes Each administrator requesting access to EmployerAccess needs to complete the Username Policy and Usage Agreement All administrators will receive their own User ID and PIN allowing them to use EmployerAccess Can a group s third party administrator process the eligibility e Yes We require a written request from the group if they use the services of a third party on their behalf BCBSGa will need to approve the use of this third party administrator The Internet Eligibility Agreement and the Third Party Agreement will need to be signed by the group and the administrator If the group has multiple subgroups can the administrator process eligibility for all subgroups e Yes BCBSGa s system is designed to use the subgroup number to determine what groups will be viewable to the group What is the turnaround time once a group administrator has processed activity through EmployerAccess e Once the group administrator receives the message that the requested action was successfully completed the information is in the BCBSGa system within 24 hours Are groups required to submit membership forms i e enrollment change etc once activities are processed through EmployerAccess
4. Enrollment To re enroll a member who s coverage has been cancelled select Re Enroll from the Employee Dependent Details page Re enrollment follows the same process as new enrollment 7o re enroll an employee subscriber enter the requested information into each blank box or field Fields with red arrows gt gt beside them indicate required information Q if the employee has dependents to re enroll check the box next to Include Dependent if the employee has more dependents to enroll click Add Dependent Q Click Continue The remaining steps of the re enrollment process mirror the steps in the new enrollment process outlined on pages 8 12 gt 52 VM Prototype OCRA EmployerAccess Cortect Us Welcome John Smith E Prodor Finder BH Help E Log out Membership E2577 3 10017 Forms Reports Profile Employee Dependent Details Member Informaton Member Information for Re Enrollment ee Select Coverage Assign Coverage Other Coverage Subscriber Name Member ID JOHN SMITH 123456789 Subiscrdvet hdo mation Last Name First Name Middle inital Gender Addresst C Female Male Adgress2 Cm Bl te Zip Code Birth Date imar 0101970 Indicates a Required Field Group Narma Group Nurnber ABC CO 1234567 Signature y Date mmeitivyyy Mim Dole na 15089 E menetifyyyy Effect z Date oso 909
5. Help Log out gt Contact Us Membership ploye Membership Employee Dependent Details Change Coverage Change Coverage Change Coverage Step 2 optional Select Coverage Step 3 optional Assign Coverage Change Payroll Class Note Enter a new payroll class Indicates a Required Field Provider Finder Help Contact Us Subscriber Name JOHN SMITH Group Name Member ID J12345678 Group Number Change Coverage Information ABC COMPANY GA12345 Save and Exit Cancel Transaction continue gt f Log out If you added or changed a payroll class 2B click Submit not shown and your transaction is complete Note The payroll class must be the same for all active products Change Coverage Change Subgroup Select new coverage Q Click Continue F etruscy 2 2007 02 51 56 FM Prototype 1DCD20A EmployerAccess Welcome John Smith Provider Finder Help E Log out Membership KOL O Menbership f Bunscnber Name Member ID Current Coverage Current Plan Nismbar Effective Oate New Coverage Dental Coverage Current Coverage Qurrent Plan Number Efecto Dale New Coverage PPOG 05012003 Seiect One DENTAL NEW GA BUSINESS ONGA 05012003 DNGA DENTAL NEW GA BUSINESS gt Indicales a Required Field JChange Coverage f Select Coverage Contact Us IE DNE IB En EZ Cancel Coverag
6. Jenolces Invoice Details Invoice Details SWI Select Billing Period lmeokce august 2006 0005242463 E dneoice t 0005242460 Biling Ent amp y Number 1234567001 Billing Period 0501 2006 08 31 2006 Biling Entity Name ABC CO Paymeet Due Date 00 01 2006 001 n1 123456789 123456789 SMITH JOHN we 5 857 05 pana 123456789 123456709 SMITH JOHN 772 ME 1 291 07 Dn 122456708 173456709 SMITH JOHN M 5 057 05 wi 122456799 122456709 SMITH JOHN X4 ME 1 201 07 ns 123456788 123456789 SMITH JOHN Ef 201 07 Tro 123466768 123466789 SMITH JOHN ME 1 291 07 n 123456789 123455789 SMITH JOHN we 6 957 05 Tus 122456789 123456709 SMITH JOHN ME 557 05 n e 123456188 123456709 SMITH JOHN we t 291 07 m 10 t2356709 123450789 SMITH JOHN ME 2 057 05 n tt 122456789 123456709 SMITH JOHN ME t 291 07 Cf 12 121456799 123456789 SMITH JOHN ME 5 257 05 Fo 12456798 123456789 SMITH J HN we 2 4257 05 C 12456788 123456789 SMITH JOHN ME 1 201 07 m 35 123450799 122456799 SMITH JOHN ME 4 291 07 FT 45899 123456789 SMITH JOHN we t 291 07 Fo co 235678 123450709 SMITH JOHN ME t 291 07 r w 123456700 123456709 SMITH JOHN ME 201 07 C 9 122456799 123456709 SMITH JOHN ME t 291 07 Pr 3 123456788 123456788 SMITH JOHN ME 257 06 p 24 123466769 123456788 SMITH J HN 428 WE 291 07 nov 173466789 173456769 SMITH JOHN ME 1 201 07 Gc 3 123456789 123456789 SMITH JOHN ME t 291 07 on 123567 123456709 SMITH JOHN
7. PARK SMITH New Enrollment Mura Wetome JOHN SMITH roe fr Whe Bloat ismitht 73 j amp mith123 ismitn123 jsmitnt23 ismith123 jsmith123 jsmith123 jsmith123 jsmith123 03 09 2006 03 09 2006 03 01 2006 02 26 2006 02 26 2006 02 20 2006 02 16 2006 01 15 2006 0427 2005 Cortect Us GLE menporis ULL 10 16 51 PM Rerum 01 01 06 PM Resum Delete 015538 M Resume Delete 12415SPM Resume Delete 051637 FM Resume Delete 074236 PM Resume Delete 11 18 06 AM Resume Delete 12 456 AM Resume Raita 02 25 46 AM Resume Doleta Group Billing TIP Billing Entities also provides access to invoices and their details Group Billing Transaction Selection Select the group number from the Billing Entities page Billing home page to access a number of transactions on the Open Invoices page Invoices Q Click on an invoice number to view details e Using the links on the left side of the screen you can pay your bills online schedule payments view past invoices and more peer Q vou can also access some of the above functions using the buttons on the screen PM Prototipa LOCEESOA Employer LLLI MEC a Dilling lorma Reports Profe Dina Entities Open kwoites Open Invoices Pay Online How Biting EnttyNumber 1234567001 Biting Entity Name ABC CO weet a L 000524240 2 12 370 5 View Past invoices View Purs Pargemenits Wekome John Sth E Provider
8. mmy EEEEEEEESE Social Security Number Horr Phone Number Group Mone Selected x Number Language ENGLISH Origin UNKNOWN P Actual City and State names are determined by US Postal Zip Code Dependent information Last SMTH Name First f JANE Name Middle Init al Gender C Mala Famale f Include Dependent 2 Iniicales Requeed Field Birth Date 22971 meod neyy Relabonship Spouse Bacial Security asosga Number mm Reinstate To reinstate a member with no lapse in coverage select Reinstate from the Employee Dependent Details page 7o reinstate an employee and any dependents check the box marked Reinstate Member Be sure to check all applicable benefit boxes Q Click Submit Note No dependents can be reinstated on cancelled contracts unless the employee subscriber is reinstated Only dependents with the same cancel date as the employee can be reinstated on cancelled contracts innunry 22 2007 03 698 PM Prototype BCRSGA z Contact Us EmployerAccess EH Welcome John Smith Provider Finder Help Log out Membership E ae Forma Reports Profe Employee Dependent Detalls Reinstate Member Subscriber Name JOHN SMITH Group Name ABC CO Member ID 123156799 Group Number 1234567 Mese M Plan GA MEDICAL 123456711008 Name Matus ender Pelstionshin Birth Date
9. the effective date A Ifyou wish to re enroll a dependent who has previously been cancelled and has no active coverage complete the Inactive Dependent Information section The required fields will be pre populated or B If you wish to add a new dependent complete the New Dependent Information section Q Whether you re enroll a dependent or add a new dependent you will need to check the box next to Include Dependent and make sure to uncheck Include Dependent box es on any blank dependent information Click the Continue button vetore JONN SMITH Brein Ge Boso E tiste Fome Reporte Profite Subsenber Name JOHN SMITH Orup Name ARC COMPANY Mamber ID 3412345670 Oroup Number GA12345 Lvem infor mation Lmrectve Osta lomo Gi Current Members JOHN SMITH Subscriber M n 06 71 1838 SPOUSE ENROLL Spouse Female vaningse Dirth Date FewHame Rebonship Child 5 2 JA Midde inital Sacral Setuny Number LastName Dinh Dal FestName Reutionhip 57 ss Mg Missie misi Social Security Number Gender Male Female Gircaste Dependent 0 0 amp indicates a Required Fiela Add hamer Gepesdert Add Coverage Simply click Add Coverage on the Employee Dependent Details page and access this screen to add coverage to an employee s subscriber s benefits Benefits can be added w
10. 208 Mf 4 N 957 05 FT 35 12356708 123456789 SMITH JOHN ME t 291 07 Sub Totat 17 970 57 Grand Total 17 370 57 AALI Setected Members lt lt Priv Neu gt gt TIP You have the option to pay online from almost any screen in the Billing section Look for the Pay Online Now button Pay Online EmployerAccess offers you the convenience and flexibility of paying your monthly bill s online You have the option to pay multiple invoices at one time Check the box marked Pay for each invoice you choose Choose to pay using a single account or multiple accounts Q Click Continue Note You are still required to pay all invoices in a timely manner in accordance with the terms of your group contract EmployerAccess Welcome Jotm Smith a Pronger Finder o Heip a Log oul rer MILI e Rillineg uina Entities Select Payment Amount Select Payment Amount TII Suet Account Contest Us Form Reporte Profi hos iret Payer Pay using a Single Account OPay using Mutiple Accounts Group Number 1224567 Group Name ABC CO June 2006 May 2006 GAKSASCOO1 June 2006 May 2005 GAMIPACUUOT May 2006 1234567091 Pay 1 599 26 Dibad Amount 1 599 26 Amount Due 2 695 30 Adjusted Amount Pay 1 599 26 Died Amount 1 599 26 Amount Due 2 695 30 Adjusted Amount C Pay 15 450 45 Billed Amount 15 450 45 Amount Due CO Pay 15 450 45 Billed Amount
11. 5 2005 Membership 2111575 Life amp Disability Claims Tools Claims Tools EmployerAccess Welcome JOHN SMITH Provider Finder 8 Help Logout Billing Future Deliverable Find Provider Help ContactUs Logout gt Contact Us Forms Reports Profile TIP For all claims other than Short Term Disability once you have completed your online entries you will be able to print the claims form for signature and completion Submit Claim You can initiate a life and or disability claim for your employees here Fill in the required information and select a claim at the bottom Life claims e Life e Life Waiver of Premium Q Disability Claims e Long Term Disability e Short Term Disability e Loss of Sight Dismemberment Once you have completed your online entries you will be able to print the claims form for signature and completion Short term disability claims are handled over the phone y 4 2007 5 25 38 PM Erstgtepe ASRGA Cortact Ur EmployerAccess Welcome John Smah eee ree Brew Bo Membership Employer Hilbesg Lilo amp Disability Claims Tools Inisate Cisim Submit Claim As the Group Administrator you can iniSate Life andor Disability Claims for your employees here Once you have completed your online entries you will be able to print fne claims form for signature and completion It will still be necessary for you or he member Yo amp ubmt completed aed a
12. Finder E Heip E Log owt ed 12 005 Invoice Details After selecting an invoice number to review several options are available This screen displays your current invoices and the total amount due All the information on this page appears on your statement Muy 21 XU 11 EM Prototype LOGGA Contact Us Ej Welcome John Smith ly eost Finder Help E Loy t Membership Employer Fome UM Biting Exairies Open imeices Imoice Details Invoice Details mo Seloct Billing Period invoice azp 2006 0005242453 T 0005212463 Billing Entity Number 1234567001 Gilling Period 0801 2006 09 212006 Biling Entity Name ABC CO Payment Due Date 0801 2006 Subject 10 Cancellation if not pud by 9029012006 l BN Summary Pedet Summary Ol Detols Mesibersiie Details Adbusimernts BIN Summary PRIOR BALANCE ACTIVITY PRIOR BILL ACTIVITY JOLY INVOICE 8 5199203 11 513 52 TAYRENT CHECK 400001234 11 513 52 ib Ed 1 00 SYSTEM CREDIT 1 00 SUB TOTAL 1 00 PATHENTS IN PROCESS 1 00 ATTACHED AUGUST INVOICE 5242463 112 370 57 Invoice Membership Details Here you can view each employee within your group To view any billed adjustments for your group click Adjustments urs y 21 2007 11 04 00 PM Prue LOCBSOA Contact Us Welcome John Santh Provider Finder Help E Log nut Membership Eregloyer Eino Forma Weporis Profile itia Entities Open
13. First Name ID physicia ns using our on i ne 123456789 JOHN SMITH es JSMITH123 enim Please enter full first name overage elete Provider Directo ry 123456789 JOHN SMITH p MEN JSMITH1 23 123456789 JOHN SMITH Re JSMITH1 23 Resume Memini Enrollment Delete Profile 123456789 JOHN SMITH Change JSMITH123 Resume Use this tab to change your e mail address password a nd o r you r secret q uestion A Provider Finder Help ContactUs Log out Pending Activity This example shows how your Pending Activity folder might look Clicking Delete on this screen only removes the action from Pending Activity it does not cancel the subscriber s cover age Cancel Coverage can be accessed from the Employee Dependent Details page Note Subscriber information cannot be accessed if that subscriber has work pending in Pending Activity To ensure full access to all subscriber information please keep Pending Activity up to date and to a minimum EmployerAccess Membership Employer Billing Reports Pending Activity Pending Activity Group Name ABC COMPANY Group Number GA12345 O 4381234567 JOHN SMITH New Enrollment O 481234567 BILL SMITH Add Dependent O 481234567 HENRY SMITH Add Dependent O 481234567 JESSICA SMITH Add Coverage O 43812345607 DON SMITH New Enrollment O 481234967 PHIL SMITH Change Coverage O 4381234567 DONNA SMITH New Enroliment O 481234567 PAULA SMITH New Enrollment 43812324567
14. GA DENTAL NOW Ini zc Name JOHN SMITH 01 01 1970 JANE SMITH 027921971 JESSE SMITH 03 03 7000 Lite Con age Subscriber Life 05 01 2006 Q waco Er How to Correct an Incorrect Member ID Social Security number Employers If you notice an error in the Member ID Social Security number while you cec MARO ors are on the Member Information page Member Information for Enrollment you can Click Change Member ID on the nenne reci d Member Information page LastName Signature Date Enter the correct Member ID Firetname Hepe number in the blank field on the Middle in al 7 Social Secunty Change ID page not shown and Q EERON Home Phone u T address Number l click Submit amena OOOO Poston gt ona Soi 8 City a Group Number None Selected H e r P Engish You will return to the Member pens bobo I 2 Zip Code Origin None Selected Information screen for gence ef continued work indicates Required Field F Actual City and State names are delermined by US Postal Zip Code EIS WY SS Eee You can access the Change Member ID hyperlink only through this screen Note You can only change the Member ID during the enrollment process You cannot change a Member ID once the new enrollment has been confirmed on the verification screen and submitted Existing Member Maintenance Member Search To perform main
15. JOHN SMITH Subscriber 01 01 1970 05 01 2003 U2 01 2006 JANE SMITH Inactive Female Spouse 02021971 07 01 2004 02 01 2006 JOE SMITH 03 03 2000 07 01 2004 02 01 2006 GA DENTAL 1234567D006 tatus Name ste JOHN SMITH inaclie Mado Subscriber 01 01 1970 05 1 2003 02701 2006 JANE SMITH inactive Female Spouse 02 02 1971 07 01 2004 02 01 2006 JOE SMITH inactive Male Child U3 03 2000 07 01 2004 02 01 2006 Lite Coverage LIFE LIFE ype Subscriber Life Inactive 05 01 2003 02 01 2008 Edit Personal Information Simply click Edit Personal Information on the Employee Dependent Details page to access the option to change employee subscriber and dependent personal information such as address phone number etc Note Be sure to verify your changes before submitting the new information January 4 2007 05 35 20 PM Prototype ONGA Contact Ur EmployerAccess EN Weicome Jolm Sent Gl Provider Finder E Hep E Loa out Member shie Ermpboyee Dependent Details Edit Personal information Edit Personal Information Subicrber Name JONN SMITH Group Name abe CO Member 123456789 Group Number 123456 Sutiscidber Wi oersaion Last Name Erh Dae oras eneeyrry First Name Hire Dato Ru HAJS Middle intal stny Social Securty gt G usie C Female Number 106 MAIN ST Home Phone 34 Number Origin Ld 5 ANTA Language 95 Dp Code ud 345 Indicat
16. Online User Manual D 9 BlueCross BlueShield of Georgia Table of Contents Introduction to EmployerAccess page 2 New Enrollment page 5 Entering a Probationary Period page 6 Add Dependents page 7 Select Coverage page 8 Assign Coverage page 9 Other Coverage page 11 Enrollment Verification page 12 Incorrect Member ID page 13 Existing Member Maintenance page 14 Add Dependents page 16 Add Coverage page 17 Change Coverage page 18 Cancel Coverage page 20 Re enrollment page 21 Reinstate page 22 Edit Personal Information page 23 Request ID Card page 24 Life and Disability page 25 Group Function page 27 Pending Activity page 28 Group Billing page 29 Open Invoices page 29 Invoice Details page 30 Pay Online page 32 Frequently Asked Questions page 33 Introduction EmployerAccess at bchsga com your one stop health management Web tool Blue Cross and Blue Shield of Georgia BCBSGa is making it easier for you to do business with us In addition to the helpful resources already available on bcbsga com our online transaction service EmployerAccess has been updated to provide e Enhanced Content e Improved availability e Faster response times e And a clean new look We ve added Life and Disability management which allows you to manage more at your convenience The new EmployerAccess offers you even more control over employee information claim information and accuracy Error messages signal missing or incomplete inf
17. Pilot Program for Rural Georgia Hospitals Wellpoint Announces New Organizational Structure Blue Value 3000 Plan Launched Blue Cross Blue Shield Of Georgia Names New President Blue Cross Blue Shield of Georgia Announces Health Plans to Give Consumers B r Role in Health Care Decisions Click here for more information um umer driven uc Blue Cross Blue Shield of Georgia and Piedmont Healthcare Announce Contract Agreement lick here for more information about Piedmont Healthcare and BCBS Blue Cross Blue Shield of Georgia and Emory Healthcare Finalize New HMO and PPO Contracts Blue Cross Blue S of Georgia Launches 360 Health First of Its Kind Program to Provide Georgia s 3 1 Million Members with Unprecedented Access to Tools that Promote Wellness and Address lliness Site Map TIP You can navigate EmployerAccess using tabs or breadcrumbs What are breadcrumbs Hansel and Gretel used the real thing to mark their trail EmployerAccess marks your trail electronically Below the tabs are the titles of pages you ve visited which appear as links These are called breadcrumbs and they show you where you ve been If you want to get back to any one of them just click the link The Membership main page is called amas laa EmployerAccess Overview Think of it as homebase EmployerAccess Here you can start the enrollment process for new employees messes subscribers access pending activity perform a searc
18. ancellation Member 23056700 Group Number GATZ3S HoD 12345670910 dates and provider information This screen displays a list of enrolled oar s a i i 2M on members and their benefits ape ATLANTA GA 12345 Pee ure MM EN HENN E Medic al Cover age Male Subscriber 1207 4949 05mt1 003 JOHN STH Active John Smith 12245070 010 PAT SHEH Awe Famae Child O32990 06 01 2003 Jonn Semen 12345678 910 JESSIE SMITH Awe Male Child 04300992 06 01 2003 Jonn Smith 17345678 910 DNGA fect Male Suoscrioer 1200170949 05 01 2002 JOHN SMETH Actwe PAT SMITH awe Fomele Child 0312203990 06 01 2003 JESSE SMITH Active Male Child 04 20 1982 00 01 2002 Vison Cover age JOHN SMITH Actve Male Subscriber 12074949 0501 2003 PAT SMITH Awe Female Child 03 220 80 06 01 2003 JESSE SMITH Active Male Child 04 30 0982 06701 2003 Short Term Disability Short Term Desatetity Group GGL SDIS s Enfoctve Date 05 1 2003 Cancel Date Basic Life UFE LIFE Status inactive Enectve Date 05 1 2003 Cancel Date 05 01 2003 Add or Re Enroll Dependent s Simply click on Add Dependents on the Employee Dependent Details page to access this screen On this page you can add or re enroll dependents to an enrolled employee s subscriber s coverage Newborns and new spouses are eligible for coverage on the event date i e birth date or date of marriage Enter
19. any member teng aided have pnor coverage Ove ONo Name JO saam Cert Mor Relatorship Subscriber Sem Dee 01011970 Thes member has prior Coverage Ove Ot Jf Vea eviter the infoeraton wow 4 Shaw Totes Month o indicates Regata fwit Dependent befor mustaan Name JANE SMITH Relabonshp Spouse Thes member has prior coverage Ove ON If Yoa enter te wtcemason beroe Degn Date remite 3 Ers Oste jac imm Mns Show Total Morth n Gender hermano Sen Dete 02021971 indicates a Fequeed Fists Dependent Mormon Name ASSE SMT Reitonshp Chit This member has prior coverage Ove On AF Yen erdee Mee indoermation below Begin Date a estin Step 5 Enrollment Verification A verification page will appear and ask soe 3 2008 08000 P you to check the information you entered for accuracy EmployerAccess If it s correct click Submit Membership Member information Select Coverage Assign Coverage Other Coverage Enrotment Verification Q If not click Previous and Enrollment Verification make changes Bubnceibor Name JOHN SMITH Member ID 412345878 Once the information is verified and submitted a feedback page will confirm whether the employee has been successfully enrolled TT En 01 01 1970 05 01 2003 12308678 310 If the data was not successfully ommon osma te Sram transmitted to BCBSGa you will JESSE SMITH sevens Minim receive an error message Dental Covur age ON
20. certiite C Ye C No 131 Dm 41 4 P Pre DORIOA Wie LLL nca Suporter WekomeJehn Sith Boronia Finder hop E Log out Subscriber Name JOHN SMITH Orup Name Alc COMPANY Member 45678 Orup Member GANIS oven ane nf os mote wwe gt Contact us Contact Ur Step 3 Assign Coverage EmployerAccess EH The following screen appears if Se Bem aM Vi eet provider information is not required Hem Forma opua Prete i e for PPO medical plan Grolment totar bdormition Select COMM tAesign Coverage Assign Coverage for Enrollment You have two options when enrolling an pou eem employee s dependents MESE inii a Subscriber Name JOHN SMITH Group Name ABC COMPANY Either check the box to enroll all tasas a EM ene E A dependents in selected benefits Cosmaga Aasignmant Que Q Oor if individual dependents Medico coveraga HMO BLUE CROSS N05190H001 should be enrolled in a specific benefit plan simply check the ata JOHN SMITH Subscriber Male 01 01 1970 corresponding box to select imm uh ONG eui coverage for that member JESSESMITM Child Male 03 03 2000 05 01 2008 siatonshig m m Effect Dental Coverage Q This screen displays the employee s benefit selections 05 01 2006 If you missed something or JOHNSMITH Subscriber Mae 0170171970 selected the wrong benefit UR Pg teme tie mie plan you can go back by nds clicking Previous Lm ht rth 05 91 2006
21. e On the Employee Dependent Details page click Cancel Coverage The Cancel Coverage page will appear Key in the cancellation effective date Under Cancellation Reason select a reason from the drop down menu 6 Be sure you check the box next to all affected benefits Note If a cancellation date is on the first of the month coverage will terminate at midnight on the previous day i e cancel date 9 1 06 coverage ends at midnight 8 31 06 A cancellation date other than the first of the month will terminate at midnight on the date entered i e cancel date 9 15 06 coverage ends at midnight on 9 15 06 EmployerAccess Weltome John Sm h Provider Finder ge E Log s Membership EL 2E 077 forms Reports Profite Member stip J Cancel Coverage Cancel Coverage Gubscrieer Name JOHN SMITH Group Name ABCCO Member iD 1234567329 Group Number 123456 Cancelianon ntortanon Cancetahon Date Cancetaton Reason 1 Select One 2 MASSAA indicates a Required Field Modica Com ape GA MEDICAL HMO ul Narr 0501 2003 05 01 2003 JESSE SMITH 0501 2003 Dental Coverage GA DENTAL DNGA GA VISION VM Short Term Dicabl ty GA STO V28100 Status Active Effective Date 01 01 06 Lite Coverage Bartk Life UFE LIFE m Status Active Efiective Date 05 01 2003 Dependent Life UFE LIFE r Status Active Effective Date 05 01 2002 gt Contact Us Re
22. e No The group is responsible for maintaining the eligibility documentation This is noted in the Internet Eligibility Agreement under Section IV Part A Establishment and Retention of Membership Information Does BCBSGa have a minimum browser requirement e Yes Internet Explorer 6 0 or higher Does BCBSGa use passwords e Yes A User ID and PIN are assigned for all customers as they register to use the Web site What is your encryption process e BCBSGa uses 128 bit encryption starting at the login page This means that no usernames or passwords pass across the Internet in clear text Do you use Secure Socket Layer SSL e Yes 128 bit SSL certificates are installed on the server supporting the Web site ensuring an encrypted channel is established between a customer s browser and our Web site The vendor we use is VeriSign
23. es Requeed Field Dependest information Last Name sun Relabontti Spouse First Name ANE Dacis Securty 992222205 Number Middle intial c Gengar Cua C foma Birth Date 7 remedy indicates a Requeed Fins Dependent Information Last Naene imm Rel onshp craa FirstNaene JESSE Social Secunty eene Number Middle intial s Gengar Mye C fomaw Bir Date lmvas indicales a Required Fitis Request ID Card Requesting ID Cards is quick and easy Simply click Request ID Cards on the Employee Dependent Details page Select Members for whom you d like to request a card Q Click Submit A confirmation screen will let you know the card is on its way hare 1 2008 05 24 00 PM EmployerAccess Welone JOHN SMITH Bronte Fear Be Biogas Request ID Card Subscriber Name JOHN SMITH Member ID 412345678 JOHN SMITH JESSE SMITH JANE SMITH Member ship Employee Dependord Details Request ID Card ider Fire 2596 SUNSET DR ATLANTA GA 30345 25056 SUNSET DR ATLANTA GA 30345 2596 SUNSET OR ATLANTA GA 30345 Forms Group Namo ABO COMPANY Group Number GA12345 wae 0 Life and Disability To initiate a claim click Life and Disability on the Employee Department Details page Click Initiate a Claim on the Claims Tools page There are several different kinds of claims you can initiate Mar 1
24. h for a current subscriber or navigate easily using the tabs at EE the top vwd Wekore D Emplover cem our Tite Ch the at Cerat management system Tabs to Employer Details Billing Forms Reports and Profile are embedded at the top They give you quick access to any of these screens 2 EmployerAccess Overview displays all your pending activity To access your pending activity click View All on the right 10a Joum 1714999 J8MITW122 Q Resume or delete pending activity using the hyperlinks ee Eee to the right of the specific activity All incomplete work is automatically saved in Pending Activity Note You can also access Pending Activity from the Reports tab Any pending activity that was started in a previous version of EmployerAccess will not be shown or available o To access benefit information or make changes to a current employee s benefits enter the and first name then clicking Submit the blank box under Add New Subscriber then click Submit The first page in the new enrollment process Member Information will appear Member ID number typically the Social Security Number in the blank box under View Change Member Information then click Submit You can also reach the information by entering the last O To add a new employee enter the Member ID number typically the Social Security Number in New Enrollment TIP Steps are numbered to tell y
25. ithin 90 days of the current calendar date To Add Coverage Select the new coverage from the drop down menu Q Click Continue Us 2007 0 41 41 PM Prototepe DCERQA Ue 11 1 Errot Subscriber Corf sct Us Welcome John Sut E Prowder Finder E Help E Log out Ej Membership ES 38 7 7577 Forms LIT Merberstip Monies Information Select Coverage Subscriber Nome JOHN SMITH Group Name ABC COMPANY Marnber ID 312345679 Group Number GA12345 Corm ape biennen Payroll Class Efiective Date 03012006 Signature Date 02012006 Select Coverage Medical C e Dental Covera Mone Selected Mone Selected x Vision Coverage None Selected Short Term Digal Coverage None Selected Yes C No ves C No Subscriber Lite Dependent Lia Indicates a Required Field Cancel Transaction Change Coverage Simply click the Change Coverage button on the Employee Dependent Details page to add or change payroll classes or make changes to existing benefit coverage Here you can Enter the effective date of change A Select a new subgroup or B Add or change a payroll class If you selected a new subgroup 2A you will proceed to Select Coverage by clicking Continue Note Benefit coverage cannot be cancelled through this option June 1 2006 05 34 00 PM EmployerAccess Welcome JOHN SMITH Provider Finder S
26. mp igned paper form and all documentation for the chain to be pald Now wl walk you meough me claim by asking yOu Gores of quetti nt Ga oup Intormaren Group Number 123456 Group Name Anc co Ergioyee bein ation First Name DAN Lost Name sri Member ID 12247785 Indicates Required Field Type of Cham What type of claim is this Life Claims C us C Ute Waler of Premium Disability Claims Long Term Disanety Short Term Disability Loss of Sigh D smamberment N Group Function Employer Details Review preferences and general 1505 21 2097 11 0253 PM Prototvee BcBscA gt Contact Us group information here EmployerAccess Welcome John Smith S Provider Finder Help Log out Billing This tab allows you to view summary information for all open invoices Additionally EmployerAccess this functionality provides Overview Welcome to EmployerAccess our details on monthly activity state of the art benefits management system invoice number and total amount due Membership KZO Bill Forms Reports Profile o o0 Group Name ABCCO Group 1234567 Number Change Login Information Billing Entities 2 Reports Billing Entity Number Amount Due 1234567001 12 370 57 You can use this tab to pmen sen view Employee Rosters Last Name generate Activity Reports and help employees fi nd Member criberName Type
27. or Enrollment information appear below the employee information Complete the s ii D ser Abc information and click Add Another mami Ue vases ped Dependent for each dependent to PCIE i E enroll P rre esp jm First e 1 Orem yyy Q Otherwise click Continue end tensa l MAs Social Gender Mele O Female irc Address Home Phone Address Nutar City P E eon None Steced Cate a om Dione Selected m OO eooo pats EE E mdkaws Regured Fio gt Actus Oty and State names are daterminad ty US Postal Zip Code Reistonitip Soci Security Narker funt Made intial Gender bim Dus retatvyyy Indude Depencem F mokadis a Required Field A01 Arother Dependent TI rm Step 2 Select Coverage Use this screen to select coverage for employees subscribers and if applicable dependents o If your group uses payroll deduction enter that information in the Payroll Class field To complete this step simply click the drop down arrow and select the appropriate medical vision life disability and or dental coverage When finished click Continue EmployerAccess Mendes tap Member hfermation Select Coverage Select Coverage for Enrollment Segnatere Dare 92912096 Seber d i ovt ajo Medical Ci tone Seicie Venton Cover Nona Selected B Shot Term D Cover meos Selected E didel C ves C No Depen
28. ormation and electronic prompts guide you from one step to the next This manual offers step by step instructions on how to effectively use EmployerAccess If you have specific questions refer to the Table of Contents or the FAQs page in the back of the manual Getting Started 1 Visit bcbsga com and click the Employers tab Click the orange Login button Enter your User ID and Password and click Login Now you re ready to begin using EmployerAccess There are links on the Login page to help you if you ve forgotten your password or need to retrieve your User ID BlueCross BlueShield of Georgia Visitors Members Agents Brokers Providers Register Now Sign up now Learn More Requires Separate Logon COBRA Solutions 9 Pharmacy Employer Access Demo ERG Login If you are already a Welcome to Healthy Extensions A program that he ur members ta ole in shaping healthy Get the Power of Blue Working for You es Learn More Women s Health ed Employer log on Need to find a Doctor Group Certificate Booklets EAP amp Work Life Services Frequently Asked Questions Employer Access Manual Employer Reference Guide 360 Health Progam or Hospital Check the Online Provider Director Medicare Part D y Quality Programs Employers Spotlight The Georgia Department of Insurance and Blue Cross Blue Shield of Georgia Launch Teleradiology
29. ou where you are in the enrollment process All steps must be completed before an employee is enrolled If at any time you click Save and Exit your work will be saved in Pending Activity Please note that the new enrollment is not complete until you have clicked Confirm on the Enrollment Verification Screen Step 1 Member Information n2 This is the beginning page to start EmployerAccess the enrollment process vekata JOHN SMT eem Free ee Blusos To enroll an employee subscriber Mombersie Member teston enter the requested information Member Information for Enrollment into each blank box or field Fields with red arrows gt gt beside them indicate required information o9 If the employee has dependents Last Name amp gnoture Cane to enroll click Add Dependent First Name Hie Date Misala initial Soeist Security Oshin Number Q if there are no dependents pane Hom Frane to enroll click Continue paseon Probason Too iano Saleciad 3 Oty Group Number i None Selected j State Language Engish 5p Code Origin None Selected Birth Cabe Indicates Required Field t by and State names TIP If you did not complete all required information an error message will appear telling you which field needs to be completed You won t be able to continue to the next screen until completing the required fields Member Information rT Entering a Probationary Pe
30. riod eo If you have only one probationary period the effective date of coverage is calculated based on the date entered in the Hire Date field 2 If you have multiple probationary periods i e Some ee a paar noia an exempt employee is eligible for coverage on the first day of the month following the emp PORTET E date of hire and a non exempt employee is 7 eligible for coverage on the first day of the sew 5 o rensie col month following the date of three months i d of continuous employment see note M d Group Nanber fune Sencha j below click the drop down box for gt r Probation Type and select the appropriate empe e type The employee s effective date of SUNN Ls iE coverage will be calculated based on the pum O Hire Date and the Probation Type mm Q if the Employee has dependents to enroll click Add Dependent 4 If the Employee does not have dependents to enroll click Continue requirements and satisfy their waiting period referred to as probationary period as defined in your Group Master Application Step 1 Members Add Dependents retrum 3 2061 025012 PM i Penta Osa This step is applicable only if you want to add dependents to the employee s EmployerAccess benefits This option is only available for vietcome Jum SB Pronger Finder E Heip E Log ot new enrollees Fields requesting dependent Member Information f
31. tenance on a specific employee and or dependent first search for the employee in EmployerAccess There are two ways to search 1 Enter the employee s Member ID Social Security Number or HCID Health Card Identifier and click Submit You can also search by entering the employee s last name first name optional A list of search results will appear Choose the correct name by clicking Select Your search will bring up an Employee Dependent Details page from which you can view specific information about an employee and easily access different benefit options by using the buttons displayed ro Welcome to ErrgtovenAcceta our State oF the wt tenetis management ritem Billing Entities Pending Activity 17456789 JOHN SMITH J8MITH 23 123456769 JOHN SMITH AGI J8MITH 23 Coverage 1244615 JOMNGWTM Re J8MITMI2 Enrolment 123456769 JOHN SMITH Change J8MITH123 Coverage View Chang Mesrsber inicr LI Member D of HCID LaviName FrsiNeme Fiesse enter AA fiit nama Employee Dependent Details EPE EmployerAccess E weisoee JOHN SMITH Brrowesfoce Bs Broce Employee Dependent Details offers a quick overview of employee and dependent information including Hennersie EmpiovtaDapen dont Oatais coverage name s address Employee Dependent Details birthdate s relationship code for Subscriber Name JOHN SMITH Group Name ABC COMPANY dependents effective c

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