Transcript Click to the Report

USING THE
AVAILITY
WEB PORTAL
TO BUILD A
HEALTHIER BUSINESS
DENISE PULCIFUR
AGENDA
About Availity
Claims Management Tools & Services
–
–
–
–
–
–
–
–
–
Claim Status Inquiry
Anthem Secure Messaging
Humana’s Claim Correction w/attachments
Medical Records Management
Claim Reconciliation Report
Professional/Facility Claim Submissions
Remittance Viewer
Remittance Review
Authorization Inquiry
What’s Coming
About Availity
ABOUT AVAILITY
Availity delivers revenue cycle
and related business solutions
for health care professionals
who want to build healthy,
thriving organizations.
ADDITIONAL PRODUCTS
5
About Availity
THE AVAILITY WEB PORTAL
• One website
• Multiple payers
• One login
• Secure and compliant
• Same look and feel
regardless of payer
About Availity
THE AVAILITY WEB PORTAL
Secure access to the health plans you need most.
Aetna
Anthem
Cigna
Humana
Medicare
Other Blue Plans
United Healthcare **
** Additional registration step required for access.
Availity and your practice
OFFERINGS BY HEALTH PLAN
Maine Offerings by Health Plan
Eligibility and benefits
Claim status
Professional and facility claims
Referrals and authorizations
Patient care summary
Patient payments
Patient cost estimator
Real-time claim adjudication
Remittance viewer/ERA*
Secure messaging
Care reminders
Claim research tool
* Enrollment may be required
Aetna
Anthem
Cigna
Humana
Medicare
Availity and your practice
THE AVAILITY
WEB PORTAL
IMPROVING YOUR WORKFLOW
Availity and your practice
HELPFUL HINTS TO INCREASE
EFFICIENCY
•
Manage Providers
•
Field Level Help
•
Data persistence: Begin all transactions with an Eligibility & Benefits
Inquiry
– Humana offers View Member ID card, if Member ID not known.
– Cigna allows name search for the member ID
•
Online Batch Inquiries
Availity and your practice
REAL-TIME CLAIM STATUS INQUIRY
You can use the Claim Status Inquiry feature to view claim
status and review results for claims that the payer
adjudicated.ed.
Availity and your practice
ANTHEM SECURE MESSAGING
Secure messaging allows a user to send a question online
about a claim directly to Anthem Customer Service
departments for the following member claims:
• Local Maine
• National
• Medicare Advantage
• BlueCard®
• FEP (Federal Employee Program) d.
LET’S TAKE A LOOK
SECURE MESSAGING
© Availity, LLC. All rights reserved.
14
SECURE MESSAGING
The Secure Messaging
screen allows you to
enter in all necessary
information for the
question on the claim.
The dropdown menu
has several common
question types to
choose from.
Use the free-form text box to
add any additional information
related to your question.
© Availity, LLC. All rights reserved.
15
VIEWING SECURE MESSAGE
RESPONSES
© Availity, LLC. All rights reserved.
16
VIEWING SECURE MESSAGING
RESPONSES
© Availity, LLC. All rights reserved.
17
Availity and your practice
HUMANA’S CLAIM CORRECTION
WITH ATTACHMENTS
Availity offers a link to Humana's Claims Correction
tool, located at Humana.com, which eliminates claim
payment delays and postage costs by allowing
providers to correct professional and institutional
claims electronically.
HOW
DOES IT
WORK?
HUMANA’S CLAIM CORRECTION
WITH ATTACHMENT
20
Availity and your practice
HUMANA’S CLAIM RECONCILIATION
REPORT
Availity provides a link to the Claim Reconciliation tool
(CRT) offered by Humana. It is an online tool that assists
providers with managing their accounts receivables by
allowing the provider to view the status of multiple claims
submitted within a 30 day date range.
HUMANA’S CLAIM RECONCILIATION
TOOL
22
Availity and your practice
PROFESSIONAL / FACILITY WEB
CLAIMS SUBMISSION
• Online claim confirmation of claim submittal
• Humana provides real-time claim adjudication at submittal
for professional claims.
• Submit a new, corrected or voided claim for available
payers.
PROFESSIONAL / FACILITY WEB
CLAIM SUBMISSION
24
Availity and your practice
WORKER’S COMPENSATION CLAIM
ATTACHMENTS
• Submit the claim (eBill)
• If the Worker’s Comp plan requests additional information, you
will receive a PDF file in the ReceiveFiles mailbox.
• The PDF file will have a bar code and a patient name on it and will
state what kind of documentation is requested.
• You use this PDF as a fax cover sheet and fax the documentation
to the fax number on the PDF coversheet.
• Electronically, register for Medical Records Tool.
• Refer to Payer Resources under the Worker’s Compensation link
for the “WORKER’S COMPENSATION COMPANION GUIDE” for
steps to follow and additional details.
Let’s take a look at submitting a web-entered claim
SUBMIT WORKER’S
COMPENSATION ECLAIMS
26
WORKERS COMPENSATION
COMPANION GUIDE
27
Availity and your practice
REMITTANCE VIEWER
• Access accurate ERA information quickly and easily
• View detailed summaries of checks, claims
• Streamline the accounts receivable process
HOW ARE
THEY
ACCESSED?
REMITTANCE VIEWER
30
ERA ENROLLMENT
31
Availity and your practice
ACCESSING ANTHEM ONLINE PROVIDER
SERVICES (AOPS) VIA MY PAYER
PORTALS
• My Payer Portals
– Anthem Provider Portal link
Remittance Advice Inquiry
Clear Claim Connection
ANTHEM ONLINE PROVIDER SERVICES
(AOPS) VIA MY PAYER PORTAL
33
Availity and your practice
AUTHORIZATION INQUIRY
You can also view the results of an existing authorization or
referral or inquire about the status of a request using this
feature.
AUTHORIZATION INQUIRY
35
WHAT’S COMING?
ELIGIBILITY AND BENEFITS
37
ELIGIBILITY AND BENEFITS
38
ELIGIBILITY AND BENEFITS
39
THANK YOU
Denise Pulcifur
Market Specialist, Northeast
207.310.0631
[email protected]
www.availity.com
(800) 282-4548