Instant Provider Access to Patient Eligibility and Benefits

Home    |   Providers

Easy Access for Providers

We work with health care providers and give them direct access to patient information via our convenient and proprietary online tool Online Provider Information System (OPIS). Providers can look up eligibility, deductibles, claim status, benefit plan information and more so that they do not have to call customer service to obtain such information. 

Online Provider Tool

 

OPIS

Online Provider Information System (OPIS) is a free tool available to our providers to easily access patient information such as eligibility, deductibles, claim status, and benefit plan information.

Phone Support

OPIS is offered to providers free of charge and is available 24 hours a day, seven days a week through our interactive intelligence phone system (IVR). Below are helpful phone line shortcuts for Providers to access account information quickly.

Call  1-800-649-9121

 

Provider Menu
  • For Provider Services press 1
    • For Confirmation Number Press 1
  • For Credit card recently received Press 0
  • For Claim status/Eligibility & Benefits Press 1
  • For pre-cert information Press 2
  • For RX prior authorization Press 3
  • For Mailing address/electronic claims setup Press 4
  • For Questions regarding Provider contracts Press 9
  • Press * repeat menu
For Credit Card Recently Received
  • From Main Menu Press 0 (For Credit card recently received)
  • For Processing Card payment Press 1
  • For Letter Received Press 2
    •  For questions on EOB Press 1
  • For all other services Press 3
    • For questions on EOB Press 1
  • To repeat menu Press 4
For Processing Card payment
  • From Main Menu Press 0 (For Credit Card Recently Received)
  • Process payment Press 1
    • For questions on EOB Press 1
  • To opt out Press 2
    • For questions on EOB Press 1
For Claim Status & Eligibility
  • From Main Menu Press 1 (For Claim Status & Eligibility)
  • For claim status Press 1
  • For benefits/eligibility Press 2
    • To return to previous menu Press #
    • Press * repeat menu
For Claim Status
  • From Main Menu press 1 (for Claim Status/ Eligibility & Benefits)
  • For claim status Press 1
    • Enter Tax ID #
    • Subscriber with W press 1
    • Subscriber with other letter press 2
    • SSN press 3
  • Enter 8 digits after W
    • If correct press 1
    • To reenter press 2
    • To return to previous menu Press #
  • Enter Date of Birth
    • 2 digits for the month 2 digits for the day 2 digits for the year (e.g. 01/01/01)
      • If correct press 1
      • To reenter press 2
      • To return to previous menu Press #
  • Enter Date of Service 2 digits for the month 2 digits for the day 2 digits for the year (e.g. 01/01/01)
    • If correct press 1
    • To reenter press 2
    • To return to previous menu Press #
  • Enter Billed amount
    • Enter dollar amount no cents press #
    • Enter cents amount press #
      • If correct press 1
      • To reenter press 2
      • For additional claim info Press 1
        • For additional Claims for this member press 1
      • For another patient press 2
      • Eligibility & Benefit on this patient or other press 3
For Eligibility & Benefits
  • From Main Menu Press 1 (Claim Status & Eligibility)
  • For Eligibility & Benefits Press 2
  • Subscriber with W press 1
  • Subscriber with other letter press 2
  • SSN press 3
  • Enter 8 digits after W
    • If correct press 1
    • To reenter press 2
    • Press * repeat menu
  • Enter Date of Birth
    • If correct press 1
    • To reenter press 2
    • Press * repeat menu
  • For Medical press 1
  • Dental press 2
  • Vision press 3
  • Pharmacy press 4
For Medical Eligibility & Benefits
  • From Main Menu Press 1 (Claim Status & Eligibility)
  • For Eligibility & Benefits Press 2
  • Subscriber with W press 1
  • Subscriber with other letter press 2
  • SSN press 3
  • Enter 8 digits after W
    • If correct press 1
    • To reenter press 2
    • Press * repeat menu
  • Enter Date of Birth
    • If correct press 1
    • To reenter press 2
    • Press * repeat menu
  • For Medical press 1
  • For Eligibility press 1. As of today (date) Eligibility effective date:
    • For additional Eligibility for this patient press 1
    • For another patient press 2
    • Claim status on this patient or other press 3
  • For Eligibility and Benefit press 2. As of today (date) Eligibility effective date:
    • For General benefits press 1
    • For Deductible/Accumulations press 2
    • For OOP/Stop Loss press 3
    • For Claim mailing address press 4
      • For professional press 1
      • For participating facility claims press 2
      • For non-par facility claims press 3
  • Press 0 to speak to a Customer Service Representative
  • Press * to repeat menu
  • Press # to return to previous menu
For Dental Eligibility & Benefits
  • From Main Menu Press 1 (Claim Status & Eligibility)
  • For Eligibility & Benefits Press 2
  • Subscriber with W press 1
  • Subscriber with other letter press 2
  • SSN press 3
  • Enter 8 digits after W
    • If correct press 1
    • To reenter press 2
    • Press * repeat menu
  • Enter Date of Birth
    • If correct press 1
    • To reenter press 2
    • Press * repeat menu
  • Dental press 2
  • For Eligibility press 1. As of today (date) Eligibility effective date:
    • For additional Eligibility for this patient press 1
    • For another patient press 2
    • Claim status on this patient or other press 3
  • For Eligibility and Benefit press 2. As of today (date) Eligibility effective date:
    • For Plan type and Network press 1
    • For Deductible/Maximums press 2
    • For Co-insurances, press 3
    • For frequencies press 4
    • For dental history/specific codes Press 5
      • For professional press 1
      • For participating facility claims press 2
      • For non-par facility claims press 3
  • Press 0 to speak to a Customer Service Representative
  • Press * to repeat menu
  • Press # to return to previous menu
For Vision Eligibility & Benefits
    • From Main Menu Press 1 (Claim Status & Eligibility)
    • For Eligibility & Benefits Press 2
    • Subscriber with W press 1
    • Subscriber with other letter press 2
    • SSN press 3
    • Enter 8 digits after W
      • If correct press 1
      • To reenter press 2
      • Press * repeat menu
    • Enter Date of Birth
      • If correct press 1
      • To reenter press 2
      • Press * repeat menu
  • For Vision Press 3
  • For Eligibility press 1. As of today (date) Eligibility effective date:
    • For additional Eligibility for this patient press 1
    • For another patient press 2
    • Claim status on this patient or other press 3
  • For Eligibility and Benefit press 2. As of today (date) Eligibility effective date:
    • For Network name press 1
    • For deductible/general benefit press 2
    • For Out of Network Benefits press 3
    • For Additional Information/Authorizations press 4
  • Press 0 to speak to a Customer Service Representative
  • Press * to repeat menu
  • Press # to return to previous menu
For Pharmacy Eligibility & Benefits
    • From Main Menu Press 1 (Claim Status & Eligibility)
    • For Eligibility & Benefits Press 2
    • Subscriber with W press 1
    • Subscriber with other letter press 2
    • SSN press 3
    • Enter 8 digits after W
      • If correct press 1
      • To reenter press 2
      • Press * repeat menu
    • Enter Date of Birth
      • If correct press 1
      • To reenter press 2
      • Press * repeat menu
  • For Pharmacy Press 4
  • For Eligibility press 1. As of today (date) Eligibility effective date:
    • For additional Eligibility for this patient press 1
    • For another patient press 2
    • Claim status on this patient or other press 3
  • For Eligibility and Benefit press 2. As of today (date) Eligibility effective date:
    • For Pharmacy benefit manager press 1
    • For Copay Information press 2
  • Press 0 to speak to a Customer Service Representative
  • Press * to repeat menu
  • Press # to return to previous menu
For Pre-cert information
  • From the main Menu, Press 2 (for Pre-cert Information)
  • For Inpatient/Medical/Mental/Substance Abuse/Home health/Infusion therapy/Chemotherapy Press 1
  • For Cedar Health and Wellness plans Press 1
      • For authorization press 1
        • For new or prior authorization press 1
          • For coordinator press 1
      • For existing authorization press 2
      • Press * repeat
      • Return to previous menu press #
    • For case management press 2
      • Dial extension or hold for rep
    • For customer service press 3
  • For any other plans Press 2
    • For authorization press 1
      • For new or prior authorization press 1
        • For coordinator press 1
      • For existing authorization press 2
      • Press * repeat
      • Return to previous menu press #
    • For case management press 2
    • For customer service press 3
  • For outpatient services / physical, occupational, speech therapy press 2
    • For Cedar Health and Wellness plans Press 1
      For authorization press 1
      • For new or prior authorization press 1
          • For coordinator press 1
        • For existing authorization press 2
        • Press * to repeat
        •  Press # to return to previous menu
      • For case management press 2
        • Dial extension or hold for rep
      • For customer service press 3
    • For any other plans Press 2
      • For authorization press 1
        • For new or prior authorization press 1
          • For coordinator press 1
        • For existing authorization press 2
        • Press * repeat
        • Return to previous menu press #
      • For case management press 2
      • For customer service press 3
For Mailing address/Electronic claims
  • From the Main Menu Press 4 (for For Mailing address/Electronic claims)
    • For electronic claims press 1
    • For mailing address press 2
      • For professional press 1
      • For participating facility claims press 2
      • For non-par facility claims press 3
      • Press * repeat menu
      • To return to previous menu Press #
Questions for Provider Contracts
  • From Main Menu Press 9 (for Questions for Provider Contracts)
  • To confirm wants to speak to provider contract rep. press 1

Customer service can be reached at:

Mon-Fri, 7 a.m. – 5:30 p.m. PT

800-649-9121

customerservice@pinnacletpa.com

Customer service can be reached at:

Mon-Fri, 7 a.m. – 5:30 p.m. PT

800-649-9121

customerservice@pinnacletpa.com

LET’S CONNECT
Brokers/Employers EmployeesProviders