Transcript Eligibility and Benefits Inquiry - e

Rev.03.28.2011.4
Eligibility, Benefits, and Pre-certifications
Availity Customer Connection 2011
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©2011 Availity, LLC | All Rights Reserved
What We Will Cover
Streamline administrative workflow with a single, free, online
connection to multiple health plans.
• CareRead®
• Eligibility and Benefits Inquiry
• Authorizations and Referrals
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©2011 Availity, LLC | All Rights Reserved
CareRead®
CareRead lets you swipe a patient’s health plan member ID
card, containing a magnetic stripe, through a card reader device.
• Automatically populates Availity's transaction pages with
demographic and insurance information, reducing time-intensive
manual data entry.
• Works seamlessly with our Eligibility and Benefits Inquiry and
CareProfile® services for end-to-end patient processing.
• Reduces data entry errors and corrections.
• Streamlines up-front tasks to improve patient flow through the
medical practice.
• Complies with regulatory requirements and is fully secure.
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©2011 Availity, LLC | All Rights Reserved
CareRead®
Ordering card readers
• Order from a business retailer or online (search for “magnetic
card reader“). Visit Availity Help for more information.
Installing card readers
• Insert the card reader connector into the USB port on your
computer.
Using card readers
• Swipe the patient’s insurance ID card with the magnetic stripe
facing the light on the card reader.
• Many of the fields on the applicable forms are automatically
populated with the patient’s information.
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©2011 Availity, LLC | All Rights Reserved
What We Will Cover
Streamline administrative workflow with a single, free, online
connection to multiple health plans.
• CareRead ®
• Eligibility and Benefits Inquiry
• Authorizations and Referrals
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©2011 Availity, LLC | All Rights Reserved
Eligibility and Benefits Inquiry
Instantly confirm patient eligibility and benefits (E&B), including
covered services, co-payments, deductibles, and more at no
charge. No more phone calls or paperwork.
• Save money with this free service.
• Save time retrieving eligibility and benefits information from all
of your health plans in one place.
• Improve accounts receivable with up front information.
• Save time by working online, in real-time, using convenient
search criteria.
• Leverage existing software with Availity’s seamless integration.
• Fully secure and compliant with HIPAA regulatory requirements.
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©2011 Availity, LLC | All Rights Reserved
Eligibility and Benefits Inquiry
1. Click Eligibility and Benefits | Eligibility and Benefits
Inquiry.
2. Select the payer and let the page refresh.
3. Complete the required fields and click Submit.
4. View and print the results.
a.
b.
c.
d.
e.
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Click Print.
Click Edit Inquiry.
Click View More.
Click View Details.
Click additional payer link-outs for additional benefit
notes, remaining deductible, or calendar/plan year information.
©2011 Availity, LLC | All Rights Reserved
Eligibility and Benefits Inquiry Example
Partial example
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©2011 Availity, LLC | All Rights Reserved
Eligibility and Benefits Results Example
Partial
example
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©2011 Availity, LLC | All Rights Reserved
Eligibility and Benefits Results Example
Partial
example
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©2011 Availity, LLC | All Rights Reserved
Free Real-Time Medicare E&B Registration
1. Log in to the Availity portal.
2. Click My Account | Medicare E&B Registration.
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©2011 Availity, LLC | All Rights Reserved
What We Will Cover
Streamline administrative workflow with a single, free, online
connection to multiple health plans.
• CareRead ®
• Eligibility and Benefits Inquiry
• Authorizations and Referrals
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©2011 Availity, LLC | All Rights Reserved
Authorizations and Referrals
Availity’s Authorizations and Referrals feature lets you submit
authorization and referral requests in real time.
With the Authorization and Referral Inquiry feature, you can
easily check the status of existing authorizations and referrals.
• Any Availity user who represents the requesting, referring or
referred-by provider or the referred-to provider or facility can
inquire about an authorization or referral.
• In general, you can inquire about all authorizations and referrals,
including those not submitted originally in Availity. Contact the
payer to determine any exceptions to this rule.
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©2011 Availity, LLC | All Rights Reserved
Referrals
Use the Referrals feature to submit a referral request.
1.
2.
3.
4.
Click Auths and Referrals | Referrals.
Select the payer and let the page refresh.
Additional required fields display based on payer requirements.
Complete the required fields and click Submit.
Looking for a detailed referral form?
• The Referral page is a quick referral form. For a detailed
version, click Auths and Referrals | Authorizations. In the
Transaction Type field, click Detailed Auth/Referral.
Need help deciding which form to use?
• Use Availity Help or field-level help to learn more about payer
requirements.
Did you receive a pended status?
•
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Use Availity’s Auth/Referral Inquiry to check the status later.
©2011 Availity, LLC | All Rights Reserved
Referrals
Partial
example
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©2011 Availity, LLC | All Rights Reserved
Authorizations
Use the Authorizations feature to submit an inpatient or
outpatient authorization request.
1.
2.
3.
4.
Click Auths and Referrals | Authorizations.
Select the payer and let the page refresh.
Select the Transaction Type and let the page refresh.
Complete the required fields and click Submit.
Need help deciding which form to use?
• Use Availity Help or field-level help to learn more about payer
requirements.
Did you receive a pended status?
•
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Use Availity’s Auth/Referral Inquiry to check the status later.
©2011 Availity, LLC | All Rights Reserved
Authorizations
Partial
example
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©2011 Availity, LLC | All Rights Reserved
Humana 5010 Referral
• Click Show Optional
Fields links to determine
if you would like to
include any additional
information.
• Type of Service: If you
are submitting a referral
request and need to add
additional types of
services, click [+] Add
Another Type of Service
to display a secondary
Type of Service list.
Humana accepts up to
four types of services.
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©2011 Availity, LLC | All Rights Reserved
Partial example
Humana 5010 Referral, cont.
• Express Entry: If the provider is
not listed in the express entry
provider field, select Provider is
Not Listed and complete the
required fields.
• Add Another Code button: Click
[+] Add Another Code to add
additional diagnosis and
procedure information, as
needed.
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©2011 Availity, LLC | All Rights Reserved
Partial example
Humana 5010 Referral, cont.
• Find a Provider button: Click
Find a Provider to search for
providers to which you are
referring a patient.
• Find A Facility button: Click
Find a Facility to search for
facilities to which you are
referring a patient.
Partial example
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©2011 Availity, LLC | All Rights Reserved
Humana 5010 Inpatient Authorization
Type of Service:
Based on the type
of service selected,
additional required
fields may display.
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©2011 Availity, LLC | All Rights Reserved
Humana 5010 Inpatient Authorization, cont.
Humana requires one diagnosis code and allows up to four.
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©2011 Availity, LLC | All Rights Reserved
Partial example
Humana 5010 Outpatient Authorization
• Transaction Type:
Select Outpatient
from the drop down
list.
• Observation
check-box: Availity
auto-populates with
the procedure
values that are
appropriate for
Humana.
• The remaining
fields are identical
to the Inpatient
Authorization form.
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©2011 Availity, LLC | All Rights Reserved
Partial example
Authorization and Referral Link-Outs
• Availity offers links to
many health planspecific tools through
single sign-on
capability.
• Some tools require
additional steps or
registration with the
health plan for access.
• To learn more about
these payer links, click
Help at the top of any
page and click the
payer’s name under
Contents.
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©2011 Availity, LLC | All Rights Reserved
Note: Anthem
Services requires
registration.
Authorization and Referral Inquiry
View the results of an existing authorization or referral or inquire
about the status of a request using this feature.
1.
2.
3.
4.
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Click Auths and Referrals | Auth/Referral Inquiry.
Select the payer and let the page refresh.
Complete the required fields and click Submit.
View and print the results.
©2011 Availity, LLC | All Rights Reserved
Authorization and Referral Inquiry
Partial
example
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Thank you
Call 1.800.AVAILITY (282.4548)
Or visit us online at www.availity.com
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©2011 Availity, LLC | All Rights Reserved