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How to view Participants' pending and approved ZaneHealth claims

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As a Plan Administrator, you can view basic details of a Participant’s claim activity including their pending and approved claims.  
 
From your online administrator account you can view claim activity in three main areas:
 

1. Homepage

On the homepage, all Participants are listed with the amount of reimbursements due to them.  These "reimbursements due" reflect approved claims that have not been reimbursed. (Tip: If "Unpaid Claims" is greater than "Reimbursements Due" it simply means the claims they've submitted exceed the balance they have available to them at this time).  A summary of pending claims, awaiting approval, are also shown in a box at the bottom of the homepage:
 
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2. Participant Ledger

To view a specific Participant’s claim status (and all account activity), find the Participant’s name under “All Participants” and click on Ledger, to the right of their name.
 
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The Participant Ledger will show.  Under Account Summary, (3) Pending Claims shows the amount of claims that have been submitted but are unprocessed. (6) Shows reimbursements due (approved claims up to the amount of their available balance). See FAQ: What is a Pending Claim?
 
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As seen above, the "Account Activity Detail" shows all account activity including approved claims and recorded reimbursements, as well as the Participant’s balance. The details of all Participants claims are HIPAA-protected.
 

3. Participant Information Page

The Participant’s page also has some information about approved, pending and rejected claims.  From the homepage, click on the Participant’s name to see their Participant Page.

Scroll down to “Logged Communications” to view email correspondence about individual claims.  While the details of the claim is HIPAA-protected, it can give you some information about the status of pending claims as well as claims rejected (for example, if we’ve emailed the participant about an issue with the claim).
 
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Disclaimer: The information provided on this website is general in nature and does not apply to any specific U.S. state except where noted. Health insurance regulations differ in each state. See a licensed agent for detailed information on your state. Zane Benefits, Inc. does not sell health insurance. None of this information should be taken as legal or tax advice.