South Atlantic Medical Group’s eligibility department tracks and maintains current and historical eligibility information for all contracted health plans.

Eligibility is updated on a daily, weekly, semi-monthly, and/or monthly schedule as it is received from the health plan. Eligibility is also updated as needed when authorizations or claims are received for members not in the system. A detailed eligibility list is posted monthly for each Primary Care office and/or Clinic. Our provider web portal also posts current member lists for each office to utilize.

Staff configures benefit tables for each health plan benefit option to identify exclusions and provide co-pay information for each service. This information is integrated for accurate authorization and claims adjudication processes.