ADDITIONAL RESOURCES AVAILABLE ABOVE
Providers

PROVIDERS

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.

Providers

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

  • Click on the MyPlan Login button to the left.

  • Complete the New User Form and subsequent requests for information. You will need to have your Tax ID Number(s) available.

  • When your request is submitted, we will verify the information. Once this is confirmed, a link will be sent to the email you provide.

  • If a password is needed immediately, please call Custom Design Benefits and ask for the Provider Relations Department and a representative will assist you.

When You Visit Again

  • Click the MyPlan Login button to the left. Enter your USERNAME and PASSWORD at right

  • Forgot your USERNAME and/or PASSWORD? You can request a new one online if you have supplied an email address during the initial registration. Otherwise, please call Custom Design Benefits at 513-598-2929 locally or toll-free at 1-800-598-2929 from 8:00 am to 5:00 pm EST.


Submitting Claims

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.
5589 Cheviot Road
Cincinnati, Ohio 45247

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
5589 Cheviot Road
Cincinnati, OH 45247

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:

  • Hospitalizations (including Emergency Admissions within 72 hours)
  • Skilled Nursing Facility stays
  • Home Health Care
  • Hospice Care
  • Hyperbaric Oxygen (HBO) Therapy
  • Durable Medical Equipment over $750
  • Capsule Endoscopy
  • Sleep Studies and Sleep Disorders
  • Bone Growth and Neuromuscular Stimulator
  • Oncology and Renal Dialysis Services


Contact Us

Our hours of operation are 8:00 am to 5:00 pm EST, Monday through Friday

513-598-2929 Local Cincinnati Area
800-598-2929 Toll-Free