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PEAR PM: Self-service tips – Member eligibility

December 2, 2021

We are sharing tips to help providers and their administrative staff prepare for the upcoming self-service requirements that begin January 1, 2022. PEAR Practice Management (PM) offers transactions that can be used daily by your practice to provide efficient patient care. 

TIP #1: Verifying member eligibility

Use the Eligibility & Benefits transaction to obtain the following information for a member's eligibility:

  • member identification number
  • member date of birth
  • gender
  • address
  • status (of coverage for the indicated date of service)
  • group number and group name
  • group renewal date

You can search for a patient up to two years back from the current date.

Review the Eligibility & Benefits 101 user guide and eLearning course on the PEAR Help Center to learn more. 

TIP #2: Eligibility for Out-of-Area and FEP members

Obtain eligibility for BlueCard® out-of-area members using the BlueExchange® Out of Area transaction. Select Eligibility & Benefits from the options that appear. The information returned is sourced from the member's Home plan.

You can search for a BlueCard out-of-area member up to two years back from the current date.

Review the BlueExchange 101 user guide and eLearning course on the PEAR Help Center to learn more.

For Federal Employee Program (FEP) members, providers can use Highmark's NaviNet® Open Plan Central or call their customer service team at 1-866-957-7290 to obtain eligibility information.

NaviNet® is a registered trademark of NantHealth, an independent company.​


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