Use the Provider Portal to: Verify Eligibility, Check Claim Status, or Ask A Question
PLEASE NOTE: HIP Claims are not viewable with this Provider Portal. To check claims or eligibility for HIP Plan participants, please contact Custom Design Benefits by phone.
Getting Online for Healthcare Providers
This service is only available for Medical, Dental or Vision plans. It is not available for HIP Plans at this time.
Registration Process for First Time Visitors
When You Visit Again
How to Submit Claims:The information needed to submit claims to Custom Design Benefits is included on each member’s customized ID Card. To see a map of our typical ID Card, please click here. It is important to review the member’s ID Card at each visit even though Custom Design Benefits is the TPA. Other information and instructions may have changed since the member’s last visit.
In some cases, your claim may need to be directed to the PPO network first for repricing prior to coming to Custom Design Benefits. It is very important that the Employer’s name and complete group number be included on your claim. This helps the PPO route claims to us.
If claims do not need to go to the PPO first (see member’s ID Card), you can send claims to:
Custom Design Benefits, Inc.
How to Submit HIP Claims:The information needed to submit HIP Claims is outlined on each member's ID Card. Basically, we need the claim form and primary insurance Explanation of Benefits or Explanation of Payment. The claim form should include the member's unique ID and the Group number. HIP Plans are alphabetic with 6-digits. Please send claims to:
HIP Plans - CDB
Payments are issued directly to the healthcare provider. Most clients issue payment weekly and our turnaround time is typically 10 business days or less.
HIP Plans are supplemental benefits that always pay secondary to another plan. HIP plans follow the coverage rules of the primary plan (i.e., if expense is allowable under the primary plan, it would be allowable under the HIP Plan); however, benefits with HIP vary by employer group and the option selected by the employee. Prior Authorization or Precertification is not required for HIP plans.
Prior Authorization of Services
We can verify whether a service needs prior authorization or pre-certification during benefit verification. Each plan is different, so it is important to confirm whether prior authorization or pre-certification is needed so that benefits are not reduced. In general, most of our plans require prior authorization for the following:
Our hours of operation are 8:00 am to 5:00 pm EST, Monday through Friday
513-598-2929 Local Cincinnati Area