Provider Operations Guide

Eligibility & Claims for Level Health Members

Level Health members access care through established provider networks, but eligibility and claims are administered by the plan administrator. Use this page to verify benefits correctly and route claims without delays.

The network confirms participation and contracted rates.
The plan administrator confirms eligibility, accumulators, and prior authorization.
Claims should be routed using the payer details printed on the member ID card.

24/7Provider Portal

(877) 426-2162Provider Phone

Plan-SpecificEligibility Data

Open Provider Portal Call Provider Support

Know the Roles

The network provides access. The administrator handles claims.

Most claim issues come from verifying through the network instead of the plan administrator. Keep these layers separate to avoid denials, delays, and incorrect member responsibility quotes.

Plan

Level Health

Defines plan benefits, member pathways, and how coverage is structured for the employer group.

Admin

Plan Administrator

Maintains eligibility files, tracks accumulators, adjudicates claims, and issues payment.

Net

Provider Network

Provides provider directory access and negotiated rates. It does not administer Level Health benefits.

Verify

through Level Health provider channels first

Portalmy.levelhealthplans.com/providers

Phone(877) 426-2162

Have ReadyMember ID + Group Number

ClaimsUse payer details on ID card

What only the administrator can confirm

The network can validate participation status. It cannot provide member-specific benefit details for Level Health plans.

Real-time eligibility and active coverage for the date of service
Deductible and out-of-pocket accumulators
Copay and coinsurance by service type
Prior authorization requirements for the member's plan
Plan-specific $0 pathways and benefit exceptions

Verification Standards

Use this checklist before service and before claim submission

Confirm network participation

Use the network shown on the member card to confirm you are in-network.

Verify eligibility in Level Health channels

Check coverage and benefits in the provider portal or by phone.

Check prior authorization requirements

Confirm authorization needs against the member's actual plan data.

Quote patient responsibility accurately

Use returned copay, deductible, and coinsurance values from the administrator.

Submit claims to the correct payer

Route claims using the payer and mailing details listed on the member ID card.

Escalate unresolved status quickly

If a system shows inactive or unknown coverage, contact provider support immediately.

Where to verify what

Question	Correct Source	Why
Am I in-network?	Network directory on member card	Network controls participation and contracted rates.
Is this member eligible today?	Level Health provider portal or phone line	Administrator owns active eligibility files.
What does the member owe?	Level Health provider portal or phone line	Administrator tracks accumulators and cost-share values.
Does this service require prior auth?	Level Health provider portal or phone line	Requirements can differ from generic network rules.
Where do I submit claims?	Payer details on the member ID card	Claims must route to the plan administrator for adjudication.

01 Our system says the member is not active. What should we do? +

Use the ID card payer details and verify directly with Level Health channels.

Some EMR and clearinghouse workflows default to network-level eligibility checks, which may not reflect plan-administrator eligibility for self-funded structures.

If your workflow returns inactive or unknown status, use the provider portal or call provider support with the member ID and group number before turning the patient away.

02 Can we rely on the network portal for benefit details? +

No. Use network tools for participation only, not benefit verification.

Network systems do not hold Level Health member-specific accumulators, exact copays, or plan-level prior authorization requirements.

Benefit verification should always come from the Level Health provider portal or provider support line.

03 Where should claims and claim status requests go? +

Submit and track claims using the payer details printed on the member ID card.

The card includes the payer name, claims mailing address, and verification channels your billing team should use. These card details should be treated as the source of truth for claim routing.

This prevents misrouted claims and reduces avoidable rework.

Need help with a specific Level Health claim?

The provider services team can walk your office through eligibility verification, claim routing, billing questions, and prior authorization requirements.

Open Provider Portal Call (877) 426-2162