Eligibility, Benefits, and Pre-certifications

Name: Eligibility, Benefits, and Pre-certifications
Uploaded: 2017-09-09T15:00:41+00:00
Duration: PTM20S59
Channel: Shawna Bolstridge
Description: Eligibility, Benefits, and Pre-certifications

Eligibility, Benefits, and Pre-certifications
Rev Eligibility, Benefits, and Pre-certifications Availity Customer Connection 2011 ©2011 Availity, LLC | All Rights Reserved

©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 During this part of today’s conference, I will go over some general navigation and tips that you can use in Availity. Next, I’ll share with you some of Availity’s Administrative services including CareRead, which is a card swipe data entry option that supports E&B and other services, Eligibility and Benefits Inquiry, and Authorizations and Referrals, both for submission or requests and inquiries on existing requests. Throughout the presentation, I will open up times to ask questions after each demo. Question… (to engage the audience) Just out of curiosity, how much do you think Availity charges for eligibility and benefits inquires? <expected responses = free> Good answer. What about Authorizations and Referrals? ©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. <Review this slide, hold up the card reader and a sample card, explain that you will demonstrate this in just a moment with E&B, mention the same card reader can be used with Availity’s CareCollect service to swipe credit cards and pin-less debit cards to collect payments. One device, many uses.> ©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. Review this slide, stress that it is a plug-n-play device, no software to install, card readers cost between $60 and $100. Order 3-track readers. If your organization uses Availity’s CareCollect service, a card reader usually comes with it. Humana and United currently support the magnetic ID cards for OH ©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 During this part of today’s conference, I will go over some general navigation and tips that you can use in Availity. Next, I’ll share with you some of Availity’s Administrative services including CareRead, which is a card swipe data entry option that supports E&B and other services, Eligibility and Benefits Inquiry, Authorizations and Referrals, both for submission or requests and inquiries on existing requests, Claim Status Inquiry and reconciliation. Throughout the presentation, I will open up times to ask questions after each demo. Question… (to engage the audience) Just out of curiosity, how much do you think Availity charges for eligibility and benefits inquires? <expected responses = free> Good answer. What about Authorizations and Referrals? Another good answer. What about Claim Status and Claim Reconciliation? ©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. <Review this slide, in your own words> Additional info: and we are very excited to announce that you can register to view E&Bs for your Medicare patients. Your organization’s PAA must first register for this service through Availity. <demo in the live portal, click My Account | E&B Medicare to show where it is located> ©2011 Availity, LLC | All Rights Reserved

Eligibility and Benefits Inquiry
Click Eligibility and Benefits | Eligibility and Benefits Inquiry. Select the payer and let the page refresh. Complete the required fields and click Submit. View and print the results. 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. Say: in your handouts, you have these step guide to help you get started with E&B in your office. The followings slides give examples of both E&B inquiry and results pages. These are for you to take notes as I demonstrate. <In the Availity portal, describe the steps as you demonstrate how to access E&B Inquiry>. ©2011 Availity, LLC | All Rights Reserved

Eligibility and Benefits Inquiry Example
Partial example In the live portal, demonstrate swiping a member ID card through the card reader. Using one of our own cards will populate the Payer as Anthem-OH. While quickly talking through the sections, demonstrate a few of key field-level help topics: As of date… show Anthem, Humana, and Kaiser Patient ID… show Anthem, mention that users can check E&B for other state blue plans, the three letter prefix indicates the routing for Availity and Anthem; also FEP notes. Patient ID… show Kaiser Talk about the Type of Benefits Requested field. Key points include: Most payers default to Health Benefits Plan Coverage or Professional, but provide a detailed benefit options to choose from in the list Generally speaking, health benefit plan coverage is the plan level information including deductible info. ©2011 Availity, LLC | All Rights Reserved

Eligibility and Benefits Results Example
Partial example In the demo, show the following examples while highlighting the navigation buttons, coverage view more, view details, payer-specific link outs, and mention the collect payment option. ©2011 Availity, LLC | All Rights Reserved

Eligibility and Benefits Results Example
Partial example ©2011 Availity, LLC | All Rights Reserved

Free Real-Time Medicare E&B Registration
Log in to the Availity portal. Click My Account | Medicare E&B Registration. PAA or PAA delegate has to register ©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 During this part of today’s conference, I will go over some general navigation and tips that you can use in Availity. Next, I’ll share with you some of Availity’s Administrative services including CareRead, which is a card swipe data entry option that supports E&B and other services, Eligibility and Benefits Inquiry, Authorizations and Referrals, both for submission or requests and inquiries on existing requests, Claim Status Inquiry and reconciliation. Throughout the presentation, I will open up times to ask questions after each demo. Question… (to engage the audience) Just out of curiosity, how much do you think Availity charges for eligibility and benefits inquires? <expected responses = free> Good answer. What about Authorizations and Referrals? Another good answer. What about Claim Status and Claim Reconciliation? ©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. Next, we’ll explore Availity Authorization and Referral, or what we call Auths and Referrals, options. Availity’s Health Care Services Review feature lets you submit authorization and referral requests in real time. With the Health Care Services Inquiry feature, you can easily check the status of existing authorizations and referrals. With the inquiry, it doesn’t matter how referral or authorization came to the payer’s system, you will be able to inquire on it through Availity. <read list of participating payers> ©2011 Availity, LLC | All Rights Reserved

Referrals Use the Referrals feature to submit a referral request. 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? Use Availity’s Auth/Referral Inquiry to check the status later. Slide #XX in your handout provides you with the quick steps to submitting a referral and authorization requests, and the following pages provide you a place to take notes while I demonstrate. ©2011 Availity, LLC | All Rights Reserved

Referrals Partial example <in the live portal, demonstrate the referral short form, point out differences in the outpatient and inpatient short forms, then move to the demo to demonstrate quickly through the detailed form and show a sample result> <read list of participating payers> ©2011 Availity, LLC | All Rights Reserved

Authorizations Use the Authorizations feature to submit an inpatient or outpatient authorization request. 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? Use Availity’s Auth/Referral Inquiry to check the status later. Slide #XX in your handout provides you with the quick steps to submitting a referral and authorization requests, and the following pages provide you a place to take notes while I demonstrate. ©2011 Availity, LLC | All Rights Reserved

Authorizations Partial example <in the live portal, demonstrate the authorization short form, point out differences in the outpatient and inpatient short forms, then move to the demo to demonstrate quickly through the detailed form and show a sample result> ©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. Partial example The Availity menu provides you with the forms you need to submit referral requests. The payer you select determines the way in which the form displays. In most situations, depending on the payer, each form includes only those fields necessary to request the referral. Humana provides additional optional fields to be completed as needed. Note: Some payer forms may display Show Optional Fields links. Click each link to determine if you would like to include any of this information for the payer selected. If not, click the Hide Optional Fields link to hide those fields. Using the Forms: Because some payers have special requirements, each of these forms might include more sections or fields than for other payers. Click ? Next to some fields, or refer to the payer’s user manual in Payer Resources as needed to determine payer-specific requirements. For example: If the Referred To Provider Information check box is pre-selected on the Referral form, the payer requires you to complete the required fields. If you want to submit a request for the referred to facility, deselect the Referred to Provider Information check box. Select the Referred to Facility Information check box. Complete the required fields. ©2011 Availity, LLC | All Rights Reserved

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. Partial example ©2011 Availity, LLC | All Rights Reserved

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 ©2011 Availity, LLC | All Rights Reserved

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. Partial example ©2011 Availity, LLC | All Rights Reserved

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 payer’s name under Contents. Note: Anthem Services requires registration. Availity also provide several links-outs to additional payer tools and websites. We offer this, along with the payers, as a convenience to our users. This way you can easily link from Availity and, in most cases, go straight in to the tool. This is a single-sign on capability – meaning that we pass a secure token electronically that identifies you, and you won’t need to log in to the payer’s tool separately. Some of the options are included here. The first three are Humana tools, and the last one is Anthem Blue Cross Blue Shield. <review the help topic information under Humana tools and then Anthem tools> We’ll talk more about registering for the Anthem tool later on today. ©2011 Availity, LLC | All Rights Reserved

Authorization and Referral Inquiry
View the results of an existing authorization or referral or inquire about the status of a request using this feature. 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. Remember, you can use the inquiry option regardless of how the original request was made. Also, you inquire about auths and referrals if you are named somewhere in it. For example, if Dr. Jones refers a patient to Dr. Smith, Dr. Smith as the referred to provider can use the inquiry. Referring, referred to, rendering providers and facilities can do the inquiring. ©2011 Availity, LLC | All Rights Reserved

Eligibility, Benefits, and Pre-certifications

Similar presentations

Presentation on theme: "Eligibility, Benefits, and Pre-certifications"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

Eligibility, Benefits, and Pre-certifications

Similar presentations

Presentation on theme: "Eligibility, Benefits, and Pre-certifications"— Presentation transcript:

Similar presentations

About project

Feedback