Donna Jorandby, Provider Connectivity Manager
2015 Anthem Blue Cross and Blue Shield Provider Expo
This presentation contains proprietary information of Anthem Blue Cross and Blue Shield. It is intended for Anthem providers. Any redistribution or other use is strictly forbidden. 1
New Availity Web Portal Eligibility and Benefits Redesign Detail
E&B Training Opportunities Secure Provider Messaging
Enhancements Interactive Care Reviewer Updates Other Enhancements Questions
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3 Availity, an independent company, provides claims management services for Anthem Blue Cross and Blue Shield.
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• Go to www.availity.com • Click Web Portal Users Login • Enter User Name and Password
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As of June 27, 2015, you may access the new Eligibility and Benefits pages. Two ways to get to the new Eligibility and Benefits pages: • From the left
navigation menu, choose
New Eligibility and Benefits Inquiry • Choose Check
Eligibility and Benefits from the center of the screen.
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Required fields are indicated by red asterisks.
Important Note The Benefit/Service Type field will no longer default to Health Benefit Plan Coverage. Users will be able to immediately select the service type they need. HBPC detail will be a part of that return. As a reminder, the top five benefits the user selects on a regular basis will appear at the top of the drop down list.
You can now choose to run multiple eligibility and benefits inquiries in succession by checking the Submit another patient checkbox. This allows you to view the results when they are ready. Leave the checkbox unchecked and submit a single inquiry like today.
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*Add to Batch and Clear have been removed from the new screens. Submit is the only option.
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The information on the new Eligibility & Benefits screens is easier to access.
Select New Request to enter new patient information.
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• Each time an E&B inquiry is submitted, a patient card displays in the list with a status color.
• You are able to see only members they have submitted or all members submitted by their organization.
• Filtering by status of active, inactive, request error or communication error is also available.
• You can search by member, date of birth, date of inquiry, payer and more.
• Member information remains in the list for 24 hours.
• Up to 200 members will show at a time.
Payer Name Here
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Options Available Within the Results Pages:
o Edit your inquiry
o Delete the request
o Print the E&B results
o Access the value-added features, i.e. View Certificate of Coverage, when available
o See basic patient and coverage information
o See the Transaction ID which identifies that specific inquiry if follow up is needed
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• All the benefit information shows on the main page.
• You can navigate directly
to a particular benefit using the links on the left side.
• Filter the benefits in the
navigation panel by: o In Network o Out Of Network o All Networks
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The Print button on the Results page will allow one or multiple Service Type(s) to be selected for the PDF print out.
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An Auth Required indicator is positioned in a more prominent place to assist in determining if the services need authorization.
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• This feature allows providers to give Availity feedback that they can use to improve their site or pass on to the health plans. Encourage users to work in the new E&B screens and give opinions, positive and negative, via the feedback button.
• This is for general information purposes only.
Now Available! A Feedback button.
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Use the New Top Navigation Bar
• Click on the Availity logo or Home button to continue to the claims or authorization screens. This will also take you to the Availity Home page
• Access payer resources to find payer specific information
• Choose Help to find training resources or how to contact Availity
• Log out or update your profile under your account
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• Access the left navigation menu on the Availity Web Portal by selecting either Home or Availity from the new top navigation bar.
• Data will still persist like in the old E&B when you navigate from the new E&B to other functionality.
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• A link to the quick demo screen opens in a separate window the first time you access the new Eligibility and Benefits screen
• Register for a live webinar where you can interact with other users and ask questions
• Link to a recorded, on-demand webinar you can listen to any time
• Availity Web Portal Help features have been updated
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Step 1 Select Help/Get Trained from the top navigation menu.
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Step 2 Choose Eligibility and Benefits
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Step 3 Choose to register for a live webinar or toward the bottom of the page or select a pre-recorded option.
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• As of August 15, 2015, Availity retired the customer service email address of [email protected].
• Open a case with Availity from the Availity Web Portal by selecting Contact Support under the Help menu.
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• Now! Follow-up secure messages can be sent on a message that was previously answered.
• Those messages show as bolded unread messages. • There is a new column titled Messages Needing Attention and follow
up messages will show Attention Needed in that column. • When you respond back to or read the message, then you can delete
the message or it stays in your inbox with the attention needed tag.
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Now Available!
• Use the Download Secure Message link to create a pdf of the entire secure messaging text. The pdf can then be saved and printed.
• This feature is available from the Inbox and the Outbox.
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• As of June 1, 2015, you can enter ICD-10 codes for dates of service October 1, 2015 and beyond.
• Requests started via ADT, fax, eCensus, telephone, email and manual entry can now have clinical information updated or added via ICR.
• The profile option on the main page when chosen, will automatically populate the request type and case type fields.
• For inpatient requests, there is only one inpatient option on the main screen. The system determines if the services are pre, post or concurrent based on the dates of service.
• For outpatient requests, including lab only, medical and behavioral health (including PHP/IOP), the “To date” is mandatory and can be up to 365 days from the service “From date”.
• You can now add a procedure code to a request containing a cancelled code.
• Submit on-line changes for your practice profile (i.e. address changes, name change, tax ID changes, provider leaving a group, phone/fax numbers, directory listings for medical groups, physicians/other healthcare professionals, opening/closing a practice location, etc.) using the electronic Provider Maintenance Form which now can be found under the: Payer Resources Page / Anthem / Physician Change Requests /Provider Maintenance Form
• Submit post service claims clinical appeals using the new form available under the Claims Management option on the left navigation menu. For claims with a clinical denial, this new capability will allow you to download the electronic form, complete the necessary fields, gather any supporting documentation and then submit up to 10 documents at one time.
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• With the new eligibility and benefits redesign on the Availity Web Portal more information is easily accessible with less clicks.
• Choose the specific benefit/service type you need from the Benefit/Service Type drop down box.
• Training resources can be found by selecting Get Trained under the
Help menu on the new top navigation bar on the Availity Web Portal.
• Make sure to check your secure messaging inbox periodically if you are a secure messaging user.
• Recent ICR enhancements include the ability to submit ICD 10 codes and now submit all inpatient requests using only the inpatient radio button.
• Access the provider maintenance form and the clinical appeal form via Availity.
Questions? Availity, an independent company, provides claims management services for Anthem Blue Cross and Blue Shield.
Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield of Wisconsin ("BCBSWi") which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare") which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
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