release communication - availity · 5/18/2019 · check out ways in the availity learning center...

Availity Portal and EDI Clearinghouse

Release Communication © Availity, L.L.C. All rights reserved | of 29

May 18, 2019

Release Communication



May 18, 2019

Availity Portal Enhancements Availity EDI Clearinghouse Enhancements

When noted and for the purpose of this release communication only, Availity refers to the following organizations by informal name:• Humana Inc. – Humana• Blue Cross and Blue Shield of Minnesota, Inc. – BCBSMN• Health Care Service Corporation – HCSC or individually BCBSIL, BCBSNM, BCBSOK, BCBSTX• Anthem, Inc. – Anthem or individually Anthem – CA, Anthem – CO, Anthem – CT, Anthem – GA, Anthem – IN, Anthem – KY, Anthem – ME, Anthem – MO, Anthem – NH, Anthem – NV,

Anthem – OH, Anthem – VA, Anthem – WI, Empire BlueCross – NY, Empire BlueCross BlueShield – NY

TABLE OF CONTENTS

General

California ● Ohio ● Missouri

California ● Colorado ● Kentucky ● Ohio ● Wisconsin

Florida

Georgia

Georgia ● Missouri ● Ohio

Idaho ● Oregon ● Utah ● Washington

Minnesota

EDI Implementations

EDI Payer Name Changes

EDI Cancellations

B2B Implementations

B2B Cancellations



May 18, 2019

The following Availity Portal enhancements, and any Availity Help topic updates, are available with the release.

To access Availity Help, click Help & Training | Find Help at the top of Availity Portal.

If you do not see these enhancements upon login, ask your Availity administrator to grant you access to the feature. To identify your administrator, click your name in the top navigation bar, and then click My Administrators on the My Account page.

Note: These enhancements do not apply to Availity Revenue Cycle Management.

Availity Portal Enhancements



May 18, 2019

Availity Learning Center – Product Training CoursesCheck out ways in the Availity Learning Center (ALC) to learn about Availity tools. Select Help & Training | Get Trained at the top of the Availity portal. The ALC opens in a new browser tab. Search the Catalog by keyword or filter by category, and then select the Enroll button to enroll for a course. New to Availity? Get the jump-start you need! Search the ALC Catalog by keyword onboarding. Find the onboarding program that’s right for you, and then select the Enroll button to get started.

AVAILITY PORTAL – GENERAL

UPDATED ON-DEMAND COURSESIn the ALC, search the Catalog by course title to enroll for these updated training demonstrations and programs.

Availity Administrator Training – Training Demo

BCBSMN Authorization Training - On-Demand

Demo: Prior Authorization Submission – BCBSMN in the BCBSMN Prior Authorization - Training Program course

Dental - Secondary and Tertiary Dental Claim Submission - Training Demo

Claim Submission & Follow-up Training for Bridgeview Providers– Training Demo

Availity Administrator Training for Capital BlueCross Providers – On Demand

Availity Overview Training for Capital BlueCross Providers – On Demand

LIVE WEBINARSIn the ALC, click Sessions and use the interactive calendar to find the live session. You can also search the Catalog by keyword (Live Webinar). We add new titles and dates often. Look for these upcoming live webinar sessions.

Availity Administrator Training for Capital BlueCross Providers

Availity Appeals

Availity Attachments Tools

Availity Claim Status

Availity Overview Training for Capital BlueCross Providers

Availity Referrals and Fee Schedules for Capital BlueCross Providers

Claim Submission and Follow-up Training for Capital BlueCross Providers

Comprehensive Health Assessment

Express Entry for Service Providers Not Required to Have an NPI

Find a session you want to attend? Enroll in the course. The ALC will send you information to join. You’ll also receive reminder emails.

Can’t make a live session? Sessions are recorded and available in the ALC. Search the ALC Catalog by webinar title or keyword On-Demand.

Wondering if a session applies to a feature you have access to? Check course descriptions and Availity Help for details about participating payers.

NEW ON-DEMAND COURSESIn the ALC, search the Catalog by course title to enroll for these new training demonstrations and programs.

Express Entry for Atypical Providers – On-Demand

Fee Schedules for Capital BlueCross Providers – Training Demo

Coming soon: Capital BlueCross Referrals – Training Demo

Looking for courses you’ve enrolled in? In the ALC, click Catalog | Dashboard to find courses you enrolled for, started, and completed. Your Dashboard has two tabs — Enrolled Courses and Completed Courses.



May 18, 2019

R U Texting Patients? What You Need to Know


CHECK OUT THE NEW TEXTING AND SOCIAL MEDIA COURSEThere's a whole lot of texting going on out there! But what are the rules? Can I text my patients? What kind of information can I send? What are the pitfalls?

What about social media? What can I post? How should I respond to a negative post?

Join Michael Sacopulos as he shares the guidelines from the Office for Civil Rights, the 7 Keys to Safe Text, and the 5 Keys to Safe Social Media Use.

Have you seen the latest Availity Connection?

Read it NOW

To purchase the new course or one of our HIPAA courses:

1. Click Help & Training | Get Trained at the top of Availity Portal.

2. In the Availity Learning Center, click Catalog in the upper left, and then click Store in the drop-down menu.

3. Search for HIPAA and click Add next to the course you want.

Use coupon code HIPAA10 to save an additional 10% today.

https://apps.availity.com/availity/AvHelp/Availity_Connection_Newsletters.htm



May 18, 2019

Additional Payers Available for Availity Portal TransactionsAvaility is pleased to announce the following payers are now available for the specified transactions on Availity Portal.


Payer Regions Eligibility & Benefits

Claim Status

Professional Claims

Facility Claims

EncounterClaims

Dental Claims Remittance Referrals Authorizations

BRIDGEVIEW Minnesota CAPITAL BLUECROSS Pennsylvania HEALTHCHOICE SELECT Oklahoma

Base plan (available for all providers)



May 18, 2019

Availity has enhanced the claim status feature to provide a better Availity Portal experience for you.

WHAT’S NEW?A. The Claim Status page no longer

displays BETA next to the title of the page. This change reflects that claim status is no longer a beta feature.

B. If a provider tax ID was not entered in the Provider Information section on the Claim Status page, a prompt now displays requesting the user to enter a provider tax ID so that the explanation of benefits (EOB) statement (if returned) can be viewed from the claim status results. This enhancement increases success of Aetna providers viewing EOB statements.

C. If an Aetna claim went through adjustments, the adjustment amount on the line level displays in the claim status result details for Aetna financial summary reports. This enhancement gives Aetna providers more details about their claim adjustments.

Claim Status Enhancements


A

B

C



May 18, 2019

In the detailed view of the overpayments card, users will no longer see the following information:

• MRM Number

• Letter Date

• Clinical Findings Date

REVIEW THIS FEATURE1. On the Overpayments page, in the

worklist, click any card.

The detailed view of the overpayment card displays.

2. Review the information on the card.

Humana – Changes to Overpayment Card




May 18, 2019

Pilot users of the overpayments application will notice that the status counts results now have color borders added to the boxes. These colors match the status of the overpayments card.

ACCESS THIS FEATURE1. On the Overpayments page, in the

Search By field, select Status.

2. In the second Search By field, select any status.

Depending on the status that you selected, the results display in the Results – Active section.

A. Black indicates that action is required for the claim.

B. Blue indicates where more information is needed for the claim.

C. Yellow indicates the claims that have been disputed.

D. Green indicates the claims that are resolved.

Overpayments –Color Indicators on Status Counts Results


A B C D



May 18, 2019

Anthem BlueCross provider users in California, Ohio, and Missouri will be able to dispute and manage claims using the appeals application.

REVIEW THIS FEATURE1. At the top of Availity portal, click Claims

& Payments | Appeals.

2. On the Appeals page:

A. Click Filter.

B. Search for and filter claims based on status, substatus, claim number, and provider.

C. Click Apply.

D. View the search results.

Learn more on how to do an initial search for claims that you wish to initiate and take through the dispute process.

Anthem – Dispute and Manage Claims

AVAILITY PORTAL – CALIFORNIA ● OHIO ● MISSOURI

A

B

C

D

https://apps.availity.com/public/apps/home/#!/newPage?appUrl=%2Favaility%2FAvHelp%2FAvaility_Help.htm%23Appeals%2FDispute_a_Claim.htm



May 18, 2019

Pilot Anthem BlueCross BlueShield users in California, Colorado, Kentucky, Ohio, and Wisconsin are able to attach files to the Overpayment Inquiry window when they inquire or request more information on an overpayment.

ACCESS THIS FEATURE1. On the Overpayments page in the

Search By field, perform a search on the Action Required status.

2. Go to your worklist.

3. On the claim, click the action menu and select Request More Information.

4. Click the drop-down list to select an inquiry type.

5. Enter a description of the inquiry. Users can enter up to 2500 characters.

6. Click Add File to attach your file to the overpayment.

7. Click Submit.

Anthem – Add Attachments to Overpayments in Inquire Window

AVAILITY PORTAL – CALIFORNIA ● COLORADO ● KENTUCKY ● OHIO ● WISCONSIN

1 of 2



May 18, 2019

Pilot Anthem BlueCross BlueShield users in California, Colorado, Kentucky, Ohio, and Wisconsin are able to attach files to the Dispute Overpayment window when they dispute an overpayment.

ACCESS THIS FEATURE1. On the Overpayments page in the

Search By field, perform a search on the Action Required status.

2. Go to your worklist.

3. On the claim, click the action menu and select Dispute Overpayment.

4. Click the drop-down list to select the dispute type.

5. Enter a description of the dispute. Users can enter up to 2500 characters.

6. Click Add File to attach your file to the overpayment.

7. Click Submit.

Anthem – Add Attachments to Overpayments in Dispute Window

AVAILITY PORTAL – CALIFORNIA ● COLORADO ● KENTUCKY ● OHIO ● WISCONSIN

2 of 2



May 18, 2019

You can now use Availity’s new patient cost estimator app to obtain a patient cost estimate for Florida Blue members.

ACCESS THE PATIENT COST ESTIMATORDo one of the following on the eligibility and benefits results page:

A. Click Patient Cost Estimator near the top of the page.

B. Click Estimate Patient’s Cost in any of the service type sections on the Coverage and Benefits tab.

Patient Cost Estimator Available for Florida Blue

AVAILITY PORTAL – FLORIDA

1 of 3

A

B

LEARN MORE

See Using the Patient Cost Estimatorfor information about submitting patient cost estimate requests and view patient cost estimate results.

https://apps.availity.com/public/apps/home/#!/loadApp?appUrl=%2Favaility%2FAvHelp%2FAvaility_Help.htm%23Patient_Cost_Estimator%2FMain_Help%2FUsing_Patient_Cost_Estimator.htm



May 18, 2019


SUBMIT A PATIENT COST ESTIMATE REQUESTComplete the fields on the patient cost estimator request page, and then click Estimate Cost.

A. Use the Patient Cost Estimator Professional page to request a patient cost estimate for services rendered by a professional provider.

B. Use the Patient Cost Estimator Institutional page to request a patient cost estimate for outpatient services rendered by an institutional provider.


2 of 3

A B

Click the links to add procedure codes or claim lines to the estimate request.



May 18, 2019


VIEW A PATIENT COST ESTIMATEThe payer calculates the patient’s estimated responsibility using the information you submitted in the patient cost estimator request. The type of information displayed in the estimate results returned by the payer vary according to the type of provider that rendered the services for which the estimate was calculated.

A. Patient cost estimate results for services rendered by a professional provider.

B. Patient cost estimate results for services rendered by an institutional providers.


3 of 3 A B



May 18, 2019

Anthem BlueCross BlueShield providers in Georgia will be directed to a single sign-on landing page to finish the dispute process for their claims.

ACCESS SINGLE SIGN-ON PAGE1. Learn how to search for claims that you

wish to dispute.

2. On the Claim Status results page, select the claim, and then click the Dispute Claim link.

3. On the Single Sign-On page, click Accept.

The third-party application displays where you can complete the necessary information and attach any supporting documentation to begin disputing your claim.

Anthem – Dispute and Manage Claims through Single Sign-On Page

AVAILITY PORTAL – GEORGIA

https://apps.availity.com/public/apps/home/#!/newPage?appUrl=%2Favaility%2FAvHelp%2FAvaility_Help.htm%23Appeals%2FDispute_a_Claim.htm



May 18, 2019

Availity’s legacy claims status inquiry tool is being retired and replaced with a new and easier workflow to search for and view claims. Anthem Blue Cross Blue Shield provider offices in the following regions now have access to the new claims status tool located under Claims & Payments | Claim Status and Remittance Inquiry:

• Georgia

• Missouri

• Ohio

GETTING STARTED1. At the top of Availity Portal, click Claims

& Payments | Claim Status and Remittance Inquiry.

2. On the Claim Status & Remittance Inquiry page, click Claim Status.

3. Select the organization associated with the claims you want to research, and then click Continue.

Availity Legacy Claim Status Inquiry Retiring for Anthem Blue Cross Blue Shield Providers

AVAILITY PORTAL – GEORGIA ● MISSOURI ● OHIO

1

2

3

Click this link to watch the claim status demo.

Click this button to give us feedback about the claim status app.



May 18, 2019

A Tax ID field was added to the eligibility and benefits request page for the following payers:

• Asuris Northwest Health (Washington)

• Bridgespan (Idaho, Oregon, Utah, Washington)

• Regence BlueCross BlueShield of Oregon

• Regence BlueCross BlueShield of Utah

• Regence BlueShield of Idaho

• Regence BlueShield (Washington)

Note: The Tax ID field was added in preparation for the new patient cost estimator that will be made available for these payers in a future release. To use the new app, you will need to complete this field.

Tax ID Field Added to Regence, Asuris, and Bridgespan E&B Requests

AVAILITY PORTAL – IDAHO ● OREGON ● UTAH ● WASHINGTON

Tip: Use express entry to add the tax ID and NPI for the providers in your organization. When you select a provider in the Express Entry field, the NPI and Tax ID fields will be populated for you.

LEARN MORE

• See Checking Eligibility and Benefits for information about submitting eligibility and benefits requests.

• See Managing Express Entry Providers for information about adding a provider’s tax ID using express entry.

https://apps.availity.com/public/apps/home/#!/newPage?appUrl=%2Favaility%2FAvHelp%2FAvaility_Help.htm%23Eligibility_Benefits_Inquiry%2FMain_Help%2FEligibility_and_Benefits_Inquiry_New.htm

https://apps.availity.com/public/apps/home/#!/newPage?appUrl=%2Favaility%2FAvHelp%2FAvaility_Help.htm%23Maintain_Provider%2FMain_Help%2FManage_Providers.htm



May 18, 2019

AVAILABLE SOONWhen creating an outpatient authorization request, Blue Cross and Blue Shield of Minnesota providers will now receive immediate feedback as to whether an authorization is required for the requested procedure.

The check for whether an auth is required is performed after specifying the member group number, service from date, and procedure code, and then clicking Next.

A. Procedure code for which an authorization is not required.

B. Procedure code for which an authorization is required.

AVAILITY PORTAL – MINNESOTA

Checking if Auth is Required for Outpatient Procedure for BCBSMN

A

B



May 18, 2019

The following EDI enhancements are either currently available, or will soon be available for Availity EDI Clearinghouse. For assistance or additional information on any of these enhancements, please contact Availity Client Services at 1.800.AVAILITY (282.4548).

For more information, access Availity’s EDI Guidelines.

Note: These enhancements do not apply to Availity Revenue Cycle Management.

EDI Clearinghouse Enhancements



May 18, 2019

EDI ImplementationsThese payers are now available for the transmission of certain EDI transactions via EDI Clearinghouse.

EDI CLEARINGHOUSE – EDI IMPLEMENTATIONS

Payer Name Payer ID 270 276 278 837P 837I 837E 837D 835

BRIDGEVIEW FS802

HEALTHCHOICE SELECT 71070 SOUTH COUNTRY HEALTH ALLIANCE 81600


APOSTROPHE 81312

BRAIN AND SPINE NETWORK BSN01

CENTIVO 45564 CHRISTIAN BROTHERS SERVICES 38308

COMMON GROUND HEALTH COOPERATIVE 77170

HEALTHTEAM ADVANTAGE 88250


Comprehensive plan (fee-based subscription required)



May 18, 2019



Payer Name Payer ID 270 276 278 837P 837I 837E 837D 835HHS NATIONAL DISASTER MEDICAL SYSTEM NDMSA

JOHN HOPKINS HOME CARE GROUP JHHCG

LIGHTHOUSE HEALTH PLAN 31828

MOLINA HEALTHCARE IDAHO 61799 MOLINA HEALTHCARE PUERTO RICO 81794

MOLINA MEDICAID NEW JERSEY 610505

PASSPORT ADVANTAGE 97652 TEMPEST TECHNOLOGIES (UCS BASI) 89244

TRAILWEST BANK (UCS BASI) 89246

TRINITY HEALTH PACE TRNPC

UMPQUA HEALTH ALLIANCE 77503




May 18, 2019



Payer Name Payer ID 270 276 278 837P 837I 837E 837D 835UNITEDHEALTHCARE COMMUNITY PLAN KANSAS (KANCARE)

96385

UNITEDHEALTHCARE COMMUNITY PLAN MICHIGAN (GREAT LAKES HEALTH PLAN)

95467

UNIVERSITY TEXAS MEDICAL BOARD UTMBC

US DEPARTMENT OF LABOR -ENERGY 77103

VA FEE BASIS PROGRAM 12116

VIVIDA HEALTH 45488

ZENITH LUMINX 7386647821




May 18, 2019

EDI Payer Name ChangesThese payers’ names have changed for the transmission of certain EDI transactions via EDI Clearinghouse.

EDI CLEARINGHOUSE – EDI PAYER NAME CHANGES

Old Payer Name New Payer Name Payer ID

BCBSMN BLUE PLUS MEDICAID WAIVER BRIDGEVIEW FS802

BLUECROSS BLUESHIELD OF WESTERN NEW YORK

BLUECROSS BLUESHIELD OF WESTERN NEW YORK MEDICAID BCBSCAIDWNY, 246, and 00246

Old Payer Name New Payer Name Payer IDHEALTHCOMP (COMMUNITY FIRST STAR HEALTH PLAN) HEALTHCOMP INCORPORATED HCOMP





May 18, 2019

EDI CancellationsThese payers are no longer available for the transmission of certain EDI transactions via EDI Clearinghouse.

EDI CLEARINGHOUSE – EDI CANCELLATIONS

Payer Name Payer ID Expiration Date 270 276 278 837P 837I 837E 837D 835BCBSMN BLUE PLUS MEDICAID WAIVER FS802 4/10/2019

BOON CHAPMAN BENEFIT ADMINISTRATORS

74238 4/17/2019

BRIDGEVIEW FS802A 4/10/2019 CENTERLIGHT HEALTHCARE 13360 4/22/2019

HEALTHPLUS LOUISIANA 95009 4/24/2019

HEALTHPLUS MICHIGAN U8216 4/24/2019

INETICO INCORPORATED 43471 4/22/2019

MANAGED HEALTHCARE ADMINISTRATION

MHCA1 and MHCA2 4/24/2019

MED3000 CMS EARLY STEPS EM350 4/29/2019

Base plan (available for all providers) and comprehensive plan (fee-based subscription required)



May 18, 2019

EDI CancellationsThese payers are no longer available for the transmission of certain EDI transactions via EDI Clearinghouse.

EDI CLEARINGHOUSE – EDI CANCELLATIONS

Payer Name Payer ID Expiration Date 270 276 278 837P 837I 837E 837D 835MERCY BENEFIT ADMINISTRATORS 37264 4/29/2019

NORTHERN CALIFORNIA SHEET METAL WORKERS

38238 4/23/2019

PHYSICIANS HEALTHCARE PLANS 65031 4/23/2019

SOUTHERN ILLINOIS HEALTHCARE ASSOCIATION

SIHCA and UIHCA 4/24/2019

STONER AND ASSOCIATES (CINCINNATI OHIO)

31121 4/19/2019

WESTLAKE FINANCIAL GROUP INCORPORATED

90560 4/19/2019




May 18, 2019

B2B ImplementationsThese payers are now available for the transmission of certain B2B transactions via EDI Clearinghouse.

EDI CLEARINGHOUSE – B2B IMPLEMENTATIONS


HEALTHCHOICE SELECT 71070


AVERA HEALTH PLANS 10869

EMPOWER ARKANSAS 12956

JAI MEDICAL SYSTEM JAI01 MIAMI CHILDREN'S HEALTH PLAN 82832

PROMINENCE HEALTH PLAN OF TEXAS 11199

SISCO 00540





May 18, 2019

B2B CancellationsThese payers are no longer available for the transmission of certain B2B transactions via EDI Clearinghouse.

EDI CLEARINGHOUSE – B2B CANCELLATIONS

Payer Name Payer ID Expiration Date 270 276 278 837P 837I 837E 837D 835ALAMEDA ALLIANCE FOR HEALTH 10639 4/19/2019

BCBSMN BLUE PLUS MEDICAID WAIVER FS802 4/10/2019

COMMUNITY HEALTH PLAN OF WASHINGTON

CHPWA 4/29/2019




May 18, 2019

Availity is committed to providing you with comprehensive customer service and enhancements that make your Availity experience a more enjoyable one.

For questions, send an email message to us using the Contact Us page. We look forward to hearing from you.

Call us at 1.800.AVAILITY (282.4548).

Contact Availity

http://www.availity.com/about-us/contact-us/

release communication - availity · 5/18/2019 · check out ways in the availity learning center...

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