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Eligibility, Benefits, and Pre-certifications Availity Customer Connection 2011 ©2011 Availity, LLC | All Rights Reserved 1 Rev.03.28.2011.4
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 ©2011 Availity, LLC | All Rights Reserved 2
CareRead ® CareRead lets you swipe a patients 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. ©2011 Availity, LLC | All Rights Reserved 3
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 patients 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 patients information. ©2011 Availity, LLC | All Rights Reserved 4
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 ©2011 Availity, LLC | All Rights Reserved 5
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 Availitys seamless integration. Fully secure and compliant with HIPAA regulatory requirements. ©2011 Availity, LLC | All Rights Reserved 6
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.Click Print. b.Click Edit Inquiry. c.Click View More. d.Click View Details. e.Click additional payer link-outs for additional benefit notes, remaining deductible, or calendar/plan year information. ©2011 Availity, LLC | All Rights Reserved 7
Eligibility and Benefits Inquiry Example ©2011 Availity, LLC | All Rights Reserved 8 Partial example
Eligibility and Benefits Results Example ©2011 Availity, LLC | All Rights Reserved 9 Partial example
Eligibility and Benefits Results Example ©2011 Availity, LLC | All Rights Reserved 10 Partial example
Free Real-Time Medicare E&B Registration 1.Log in to the Availity portal. 2.Click My Account | Medicare E&B Registration. ©2011 Availity, LLC | All Rights Reserved 11
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 ©2011 Availity, LLC | All Rights Reserved 12
Authorizations and Referrals Availitys 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. ©2011 Availity, LLC | All Rights Reserved 13
Referrals Use the Referrals feature to submit a referral request. 1.Click Auths and Referrals | Referrals. 2.Select the payer and let the page refresh. 3.Additional required fields display based on payer requirements. 4.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? Use Availitys Auth/Referral Inquiry to check the status later. ©2011 Availity, LLC | All Rights Reserved 14
Referrals ©2011 Availity, LLC | All Rights Reserved 15 Partial example
Authorizations Use the Authorizations feature to submit an inpatient or outpatient authorization request. 1.Click Auths and Referrals | Authorizations. 2.Select the payer and let the page refresh. 3.Select the Transaction Type and let the page refresh. 4.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? Use Availitys Auth/Referral Inquiry to check the status later. ©2011 Availity, LLC | All Rights Reserved 16
Authorizations ©2011 Availity, LLC | All Rights Reserved 17 Partial example
Humana 5010 Referral ©2011 Availity, LLC | All Rights Reserved 18 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. Partial example
Humana 5010 Referral, cont. ©2011 Availity, LLC | All Rights Reserved 19 Partial example 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.
Humana 5010 Referral, cont. ©2011 Availity, LLC | All Rights Reserved 20 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
Humana 5010 Inpatient Authorization Type of Service: Based on the type of service selected, additional required fields may display. ©2011 Availity, LLC | All Rights Reserved 21
Humana 5010 Inpatient Authorization, cont. Humana requires one diagnosis code and allows up to four. ©2011 Availity, LLC | All Rights Reserved 22 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. ©2011 Availity, LLC | All Rights Reserved 23 Partial example
Authorization and Referral Link-Outs Availity offers links to many health plan- specific 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 payers name under Contents. ©2011 Availity, LLC | All Rights Reserved 24 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.Click Auths and Referrals | Auth/Referral Inquiry. 2.Select the payer and let the page refresh. 3.Complete the required fields and click Submit. 4.View and print the results. ©2011 Availity, LLC | All Rights Reserved 25
Authorization and Referral Inquiry ©2011 Availity, LLC | All Rights Reserved 26 Partial example
Thank you Call 1.800.AVAILITY (282.4548) Or visit us online at www.availity.comwww.availity.com ©2011 Availity, LLC | All Rights Reserved 27
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