Eligibility, Benefits, and Pre-certifications Availity Customer Connection 2011 ©2011 Availity, LLC...

©2011 Availity, LLC | All Rights Reserved1

Eligibility, Benefits, and Pre-certifications

Availity Customer Connection 2011

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


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.


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.


What We Will Cover


• CareRead ®



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.


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.


Eligibility and Benefits Inquiry Example

Partial example


Eligibility and Benefits Results Example

Partial example


Eligibility and Benefits Results Example

Partial example


Free Real-Time Medicare E&B Registration

1. Log in to the Availity portal.

2. Click My Account | Medicare E&B Registration.


What We Will Cover


• CareRead ®



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.


Referrals

Use the Referrals feature to submit a referral request.1. Click Auths and Referrals | Referrals.


3. Additional required fields display based on payer requirements.


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.


Referrals

Partial example


Authorizations

Use the Authorizations feature to submit an inpatient or outpatient authorization request.

1. Click Auths and Referrals | Authorizations.


3. Select the Transaction Type and let the page refresh.


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.


Authorizations

Partial example


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


Humana 5010 Referral, cont.

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.

• 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.


Humana 5010 Inpatient Authorization, cont.

Humana requires one diagnosis code and allows up to four.

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.

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 payer’s name under Contents.

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.



4. View and print the results.


Authorization and Referral Inquiry

Partial example


Thank you

Call 1.800.AVAILITY (282.4548)

Or visit us online at www.availity.com

http://www.availity.com/

Date post:	29-Mar-2015
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