How to submit claims and pre-determination requests online as a sleep supply and equipment provider

As a sleep supply and equipment provider, you can submit claims and pre-determination requests directly to Pacific Blue Cross on behalf of your clients through our online portal PROVIDERnet. This streamlines administration for your busy team, and improves access to care for patients, who won't have to pay out-of-pocket for the supplies and equipment they need.

With EFT set up, reimbursement for equipment and supplies will land straight into your business bank account - no need to wait for cheques in the mail.

Register for PROVIDERnet

Make sure your business is registered for PROVIDERnet by filling in an application form. You'll need:

• Your business contact information
• The date of your store opening
• Your City Business License
• Your Diagnostic Accreditation Program confirmation

Pacific Blue Cross will review your application and send you your login details once approved. From there, the Primary Administrator for your account will need to set up direct deposit.

How to submit a claim or pre-determination request

1. If you're submitting a claim for this client for the first time, you'll need to ask them to complete a Pay Provider Authorization Form, which gives their consent for you to submit claims on their behalf. You must keep this form on file for a minimum of three years from the date of the client's most recent claim, as Pacific Blue Cross can ask to see a copy at any point during this time.
2. In PROVIDERnet, go to Submit a claim under the Claims Select the appropriate provider office. Enter the member's policy and ID or status number. Click Search. Validate the member's identity with their first name, last name, and birthdate, using the information provided on their ID.
3. Select whether you are submitting a claim or a pre-determination request. Complete the requested information about the member and the expense.
4. You'll see a note about the mandatory and optional documents that you'll need to upload. Check the boxes to indicate which documents you will be uploading for this client. Mandatory documents for all first-time submissions are:

• • A detailed quote for required sleep equipment, and/or supplies
  • A prescription for sleep equipment or diagnosis of obstructive sleep apnea from a medical doctor or nurse practitioner
  • A sleep study showing an AHI score greater than or equal to 15. If this sleep study isn't available, a 30-day compliance report can be submitted for equipment replacements only. If the AHI is between 5 and 15, a letter from a medical doctor or nurse practitioner explaining co-morbidities may be submitted for our review.

5. Upload the documents that you selected. Review all the details of the claim or pre-determination request before you hit submit. You can edit or delete an expense if you need to.
6. A confirmation page and claim or pre-determination ID number will appear - the plan member might ask for a printed copy of this. You can also find this claim in the Claim history section of PROVIDERnet, under the Claims This is where you'll find the option to reverse a claim. Also under the Claims tab, you'll find Claim statements, which you can search by date range and download as a PDF.

Got questions? Call our customer service team on 604 419-2000.