Providers - Pinnacle Claims Management

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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.

OPIS Login

How to Read a Pinnacle Benefits ID Card

To view our quick guide flyer hot to read our benefits ID card, CLICK HERE

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 #
If HCID starts with another letter, press 2
- If HCID starts with E, press 1
- If HCID starts with J, press 2
- If HCID starts with Y, press 3
- If correct, press 1
- To reenter, press 2
- To return to previous menu, press #
Enter the Policy Holder’s 9-digit Social Security Number
- If correct, press 1
- To reenter, press 2
- To return to previous menu, press #
Enter Date of Service
- If correct press 1
- To reenter press 2
- To return to previous menu Press #
Enter Dollar amount followed by #
- Enter cents amount followed by #
- If correct press 1
- To reenter press 2
- To return to previous menu Press #
IVR will give: Claim #, Received and Finalized Date, Check #, Amount paid if claim located
- To hear additional information on claim, press 1
- To repeat this information, press *
- To return to previous menu press #
For Additional Info on Claim, press 1
- IVR to give: breakdown of Claim Ded/Co Pay/Co Ins
- To repeat this info, press *
- To hear claim info on same participant, press 1
- To hear claim info on other participant, press 2
- For eligibility on same/other participant, press 3
- To return to main menu, press #
- To speak to a customer service representative, press 0
- To repeat this menu, press *

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 Western Growers Assurance Trust, press 1
For Pinnacle Claims Management, press 2

For Cedar Health and Wellness plans Press 1
- For authorization press 1
  - For new or prior authorization press 1
  - For existing authorization, press 2
- 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 existing authorization press 2
- 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
  - If you like to send claims electronically, use our Envoy Payer ID: 24735
  - To return to previous menu Press #
- For Mailing Addresses press 2
  - For Mailing address for Professional Claims press 1
    PO BOX 2220 Newport Beach CA 92658
  - For Participating Provider Facility Claims press 2
    Please send to local Blue Cross
  - For Non-Par Provider Facility Claims press 3
    PO Box 2220 Newport Beach CA 92658
  - Press * repeat menu
  - To return to previous menu Press #

Questions for Provider Contracts, Joining our Network, Status of LOA

From Main Menu Press 5 (for Questions for Provider Contracts, Joining our Network, Status of LOA)
For joining network or Letter of Agreement status, press 1
Send email to providercontracts@wga.com
For W-9 issues, press 2
Send email to providerrelations@wga.com
For all other contract related issues, press 3
To return to previous menu Press #

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

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Instant Provider Access to Patient Eligibility and Benefits

Easy Access for Providers

Online Provider Tool

OPIS

How to Read a Pinnacle Benefits ID Card

Phone Support

Provider Menu

For Credit Card Recently Received

For Processing Card payment

For Claim Status & Eligibility

For Claim Status

For Eligibility & Benefits

For Medical Eligibility & Benefits

For Dental Eligibility & Benefits

For Vision Eligibility & Benefits

For Pharmacy Eligibility & Benefits

For Pre-cert information

For Mailing address/Electronic claims

Questions for Provider Contracts, Joining our Network, Status of LOA

Customer service can be reached at:

800-649-9121

Customer service can be reached at:

800-649-9121