1. Using the Availity Web Portal to build A healthier business denise pulcifur

2. agenda About Availity Claims Management Tools & Services What’s Coming
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

3. About Availity
About Availity
Availity delivers revenue cycle and related business solutions for health care professionals who want to build healthy, thriving organizations.

5. Additional Products

6. The Availity Web Portal
About Availity
The Availity Web Portal
One website
Multiple payers
One login
Secure and compliant
Same look and feel regardless of payer

7. Secure access to the health plans you need most.
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.

8. Offerings by Health Plan
Availity and your practice
Offerings by Health Plan
Maine Offerings by Health Plan
Aetna
Anthem
Cigna
Humana
Medicare
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

9. The Availity web Portal Improving Your Workflow
Availity and your practice
The Availity web Portal Improving Your Workflow

10. Helpful hints to increase efficiency
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

11. Real-Time Claim Status inquiry
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.

12. Anthem Secure Messaging
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.

13. Let’s take a look

14. Secure messaging
© Availity, LLC. All rights reserved.

15. 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.

16. Viewing secure message responses
© Availity, LLC. All rights reserved.

17. Viewing Secure messaging responses
© Availity, LLC. All rights reserved.

18. Humana’s claim correction with attachments
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.

19. How does it work?

20. Humana’s Claim correction With attachment

21. Humana’s claim reconciliation report
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.

22. Humana’s claim reconciliation tool

23. Professional / facility web claims submission
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.

24. Professional / Facility web claim submission

25. Worker’s compensation claim attachments
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
Features
Easy to use tool that allows you to search, view and print ERAs
View ERAs in the Availity portal for all your payers1
Search for ERAs by patient, check or claim
Access up to seven years of historic data2
Benefits
Access ERA information easily, quickly, accurately
Reduces reliance on paper EOBs for monthly reconciliation
Allows you to view check summary and claim summary detail
Streamlines the accounts receivable process
1 ERAs for BCBSIL, BCBSTX, BCBSNM and BCBSOK are currently not viewable in Remit Reader
2 If you currently receive ERAs through Availity, you can access ERAs in Remit Reader from 11/20/10 to present. If you do not currently receive ERAs through Availity, the seven years of historic data begins from the time you complete the ERA registration process.

26. Submit Worker’s Compensation Eclaims

27. Workers Compensation Companion Guide

28. Remittance viewer Access accurate ERA information quickly and easily
Availity and your practice
Remittance viewer
Access accurate ERA information quickly and easily
View detailed summaries of checks, claims
Streamline the accounts receivable process
Features
Easy to use tool that allows you to search, view and print ERAs
View ERAs in the Availity portal for all your payers1
Search for ERAs by patient, check or claim
Access up to seven years of historic data2
Benefits
Access ERA information easily, quickly, accurately
Reduces reliance on paper EOBs for monthly reconciliation
Allows you to view check summary and claim summary detail
Streamlines the accounts receivable process
1 ERAs for BCBSIL, BCBSTX, BCBSNM and BCBSOK are currently not viewable in Remit Reader
2 If you currently receive ERAs through Availity, you can access ERAs in Remit Reader from 11/20/10 to present. If you do not currently receive ERAs through Availity, the seven years of historic data begins from the time you complete the ERA registration process.

29. HOW ARE THEY ACCESSED?

30. Remittance Viewer

31. ERA Enrollment

32. Accessing anthem online provider services (AOPS) via my payer portals
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

33. Anthem online provider services (Aops) via my payer portal

34. Authorization inquiry
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.

35. Authorization Inquiry

36. WHAT’S COMING?

37. Eligibility and Benefits

38. Eligibility and Benefits

39. Eligibility and Benefits

40. Thank you
Denise Pulcifur Market Specialist, Northeast (800)