Availity Resources - e

Transcript Availity Resources - e

Welcome

Availity Customer Connection 2011

Agenda

Topic

Registration, continental breakfast, and exhibit booth visitation General introduction (Availity background, registration, PAA responsibilities) CareRead ® , eligibility and benefits, and pre-certifications (authorizations/referrals) Break and exhibit booth visitation Claim follow-up (claim status, remittance, and review) Lunch and exhibit booth visitation CareCollect ® (payment collection) and CareProfile ® (health record information) Break and exhibit booth visitation RealMed ® revenue cycle management (claim tracking, edit error management, patient statements) Claims and EDI file management (web-entered claims, EDI submission, EDI reports)

Time

8:00 am – 8:30 am 8:30 am – 9:30 am 9:30 am – 10:30 am 10:30 am – 10:45 am 10:45 am – 12:00 pm 12:00 pm – 1:00 pm 1:00 pm – 2:00 pm 2:00 pm – 2:15 pm 2:15 pm – 2:45 pm 2:45 pm – 4:00 pm • We want these sessions to be interactive, so please ask questions. • Availity and RealMed representatives are wearing branded shirts.

• Please turn in your evaluation at the end of the day so we can continue to improve these conferences!

Sponsors and Exhibitors

Availity Background

Formation

• Joint venture between Blue Cross and Blue Shield of Florida and Humana in 2001 • Partnered with THIN in 2006 and RealMed in 2010

Ownership

• BCBSF, BCBSMN, Health Care Service Corporation (HCSC), Humana, WellPoint (Anthem) • Service multiple health plans (~1,300)

Services

• Availity supports a federated, real-time model • Offer no charge basic and optional premium services • Integrate with practice and hospital systems

Goals

Availity Basic Solutions

Business Solutions

Health plan-sponsored tools— offered at no cost to providers— improve efficiency.

• • Batch/clearinghouse

Claims Remittance Advice

• • • • Real-time

Eligibility & Benefits Claim Status Referrals/Authorizations Claim Submission

• Card swipe

CareRead ®

• Patient responsibility

CareCost Estimator

SM • Payment solution

CareCollect ® Clinical Solutions

Clinical tools help support collaborative programs for improving patient care delivery and quality outcomes.

• Health record

CareProfile ®

• Electronic prescribing

CarePrescribe ®

RealMed Premium Offering

Revenue Cycle Management

Integrated and automated tools enabling the highest degree of performance optimization and self service.

Providers who use RealMed:

• • • Make 10-12% fewer health plan calls Send up to 60% cleaner claims to health plans Send nearly 10% fewer paper claims RealMed builds on the value offered by Availity’s basic solutions by

bundling and automating multiple

functions that maximize operational results.

RealMed is an integrated revenue cycle management solution that focuses exclusively on helping practices improve the efficiency of their revenue cycle processes and get paid as quickly as possible.

Support for National HIT Objectives

• Security and privacy • Compliance – HIPAA, CORE, EHNAC • 5010 information available at http://www.cms.gov/Versions5010andD0/40_Educational_Resources.asp

• Interoperability – Seamless integration with multiple systems and stakeholders • Meaningful use – Leverage widely available, consistent administrative data • Deliver quality – Real-time access to actionable, relevant patient information at the point of care • Eliminate cost – Identify fraud through medication history access; save time by improving access to important information • Improve outcomes – Reduce avoidable adverse drug events by providing alerts at the point of care

Terms to Know

Vendor, Technology Company Partner other administrative tasks.

A company that creates computer systems that provider offices and hospitals use to manage business, which may include billing, scheduling, and Payer, Receiver, Health Plan carrier responsible for paying providers and facilities for health care services.

- The insurance company or Implementation Guide - A document explaining the proper use and structure of a standard for a specific business purpose. Availity’s HIPAA validation is based on the ASC X12 4010A1 Implementation Guides and 5010 Technical Reports available from the Washington Publishing Company.

Get Registered

• Go to www.availity.com.

• Click the Registration link.

• Complete online application, print it, and sign it.

• Fax it to Availity.

• A temporary password is sent back to the Primary Access Administrator (PAA).

• Availity Client Services is available at 800.AVAILITY (282.4548).

Primary Access Administrator (PAA)

• Add users • Maintain users • Assist with registering for new products • Check for notices and updates • Assist with password resets • Maintain organization information To locate contact information for your Primary Access Administrator (PAA), log in to the Availity portal and click Who control’s my access? from the top of any page. A page displays containing your organization’s PAA and Primary Controlling Authority (PCA) information.

Logging In and Out

First time • • • Use temporary password Set up security questions and answers Set unique password Ongoing • • • • • • Forgot password options View message alerts, if displayed Reset password every 75 days Review Home page information For security purposes, log off when no longer working in Availity Availity session times out after 30 minutes of inactivity, with a 5-minute alert to click Stay Active

Availity Portal Navigation

When you log in, the Home page is displayed.

Enhancements

Recent Availity enhancements

–

Announcements

Training and Resources

resources – Links to online demos, training, lists, and

Value-Added Services

services – Links to additional Availity

Downloads

– to download necessary no charge applications Links

Availity Portal Top Navigation

User name displays.

Region displays if you are registered in more than one state.

Home, Message Center, Help, and Log Out are easily accessed. Be sure to log out at the end of the session.

Click Who controls my access? to locate the PAA and PCA for your organization. A window displays with the information.

Availity Portal Top Navigation

Availity Resources contains links to My Availity Dashboard, My Code Lists, the Availity EDI Guide, registration forms, and the Availity e-Focus newsletter archive.

Click Free Training to register for a webinar and launch on-demand webinars, if available.

Payer Resources contains payer-specific resources, such as payer companion guides and user manuals, ERA/EFT application forms, and provider directories. Each payer’s information displays on its own page, making it easy to locate the information you need.

Availity Menu

• • • • Click the menu categories to expand the list of options.

The menus are based on your unique ID and are assigned by your PAA.

Availity refers to the menu categories as roles and the menu option as permissions.

Click the menu option to display the transaction.

Completing Inquiries and Submissions

• • • • Select the payer first and allow the page to refresh with payer-specific field requirements.

Complete required fields, typically marked with an asterisk.

Click Submit to submit for an immediate real-time response.

Click Add to Batch to add the inquiry to a batch to be submitted later for a real-time batched response.

Electronic Information Exchange

• • • • When you click Submit, Availity conducts HIPAA and other front-end edits to validate the data you entered.

Availity creates and sends an electronic transaction to the health plan’s back-end system.

The health plan receives the inquiry and responds electronically.

Availity passes the response as the payer returns it.

Viewing Response Results

• • • Availity displays the information the health plan returns in a standard format.

Use navigation on the page to review and print results, edit the inquiry, and link to or display additional information.

From a results page, click another menu option to persist data.

Availity Help

• • Availity Help is accessible from any Availity page. Click Help in the upper-right corner of the page.

The help system displays in a separate browser window and is context-sensitive, meaning Availity displays the topic for the page you are viewing.

Availity Field Level Help

Field-level help offers quick information about individual fields. Click a blue question mark (?) next to a field.

Availity displays a small, separate window with field-specific help information.

Click the blue text for field requirements specific to that payer.

Availity Reports

• • • •

Transaction Logs

Web transaction details over a specific date range

My Availity Dashboard

• • • • • Web and EDI acceptance rates, error rates, etc.

Helps identify trends Benchmark against all Availity customers Top 10 EDI errors

Web Transaction Reports

Metrics by organization, payer, and user

Availity Time-Saving Tips

If this…

You forgot your password You need to contact your PAA You can’t see a pop-up window You can’t see the full screen You don’t want to type data for each transaction You need help using Availity

Do this…

On the Log In page, type your user ID into the User ID field, and then click I forgot my password. Click Who controls my access? at the top of any page to open a page containing PAA contact information.

Set Internet Explorer to allow pop-ups related to Availity.

Adjust the screen resolution of your monitor. Availity is best viewed at higher resolutions.

Start with an Eligibility and Benefits Inquiry and let the data persist to the next inquiry or submission.

Ask your PAA to set up Maintain Provider for Express Entry.

Use Availity Help, including field-level help. Contact Client Services at 1.800.AVAILITY (282.4548). Have your transaction ID and organization ID ready.

Thank you

Call 1.800.AVAILITY (282.4548) Or visit us online at www.availity.com

Availity Resources - e

Transcript Availity Resources - e

Welcome

Agenda

Sponsors and Exhibitors

Availity Background

Availity Basic Solutions

RealMed Premium Offering

Support for National HIT Objectives

Terms to Know

Get Registered

Primary Access Administrator (PAA)

Logging In and Out

Availity Portal Navigation

Availity Portal Top Navigation

Availity Portal Top Navigation

Availity Menu

Completing Inquiries and Submissions

Electronic Information Exchange

Viewing Response Results

Availity Help

Availity Field Level Help

Availity Reports

Transaction Logs

My Availity Dashboard

Web Transaction Reports

Availity Time-Saving Tips

Thank you

Directory