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Health Information Status

HEDIS

HRA

Alerts/Memos

Portal

Account

Associated Member

Mobile Phone

123-456-7890

Mailing Address

100 DC Drive,

Detroit, MI, 48223

ID CARD ACTION COMPLETED (PSD/PDT)

Enrollment Status

Primary Benefit Plan

MMP Medicare

Primary Health Plan ID

60000017361

MMP Medicaid

Secondary Benefit Plan

Secondary Health Plan ID

00038805901

Primary Eligibility Status

Active

Secondary Eligibility Status

Active

PCP Details/Case Manager

PCP Name

BAILEY, CRAIG A

Case Manager

Frankie Ruiz

PCP Phone

123-456-7890

Phone

555-123-1233

IPA Name

The Bailey Medical Group PC

Extn.

180468

Member

Status

Primary Restriction

No Restriction

Secondary Restriction

No Restriction

Account

Status

Enrollments

Member Info

Health Info

Authorization

Claims

Alerts / Memos

Marketplace

Interaction / Activity

Attributes

Secure Message

Change History

Molina Links:

http://www.deltadentalins.com/dentists

http://ipay.adp.com/iPaylogin.jsf

http://connect.cgx.com/molina/Default.aspx

http://www.deltadentalins.com/dentists

http://ipay.adp.com/iPaylogin.jsf

http://connect.cgx.com/molina/Default.aspx

http://www.deltadentalins.com/dentists

http://ipay.adp.com/iPaylogin.jsf

http://connect.cgx.com/molina/Default.aspx

http://www.deltadentalins.com/dentists

http://ipay.adp.com/iPaylogin.jsf

http://connect.cgx.com/molina/Default.aspx

Multimedia Messaging Service

One of the 3 statements were VOIDED. Please refer to the Marketplace for further details.

Member premium amount has changed after recent statement generation.

Type

Time Period

Payment Reminder

Open

April

Invoice Posting

Open

March

Autopay Confirmation

Open

June

4

2

2

0

0

2

2

0

0

0

1

0

Recent Activity

Call

Date

Activity

Status

Resolution

Created by

Assign to

Completed

Completed

Pending

Completed

2/15/2016

9:00 AM

2/15/2016

12:00 PM

2/15/2016

2:00 PM

2/15/2016

4:00 PM

Transporation

Rx Inquiry

Rx Benefit Issue

Prescription Fulfillment

Issue Resolved

Information/Education Provided

Information/Education Provided

Information/Education Provided

Sujatha Ma

Sujatha Ma

Sujatha Ma

Sujatha Ma

Kalyan Sudhir

ex: 119303

Kalyan Sudhir

ex: 119303

Kalyan Sudhir

ex: 119303

Kalyan Sudhir

ex: 119303

From

To

State

CA

Email

C.Johnston@gmail.com

Physical Address

100 DC Drive,

Detroit, MI, 48223

05/29/2015 11:34 PM

LOB

Marketplace

DOB

8/31/1981

SSN

xxx-xx-8368

Home Phone

555-555-5555

JOHNSTON, CHARLES C

Language

English

Do Not Email

Email:

X

C.Johnston@gmail.com

Preferred Contact Information

Mail:

100 DC Drive, Detroit, MI

Do Not Call

Phone:

X

Do Not Text

X

123-456-7890

Communication Preference Contact

Subscribe to Electronic Communication

YES

NO