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www.availity.com 1 JUNE | JULY 2012 in Focus Newsletter for users of the Availity ® Health Information Network Find out the answers to the questions you always wondered, but never had time to ask. LOG IN REGISTER AVAILITY.COM Tell us what you think— email us at [email protected] News Events Training Good question

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Page 1: inFocus - Availity4 Availity inFocus | June/July 2012 Good habit, bad habit Best practices in using Availity By Kristina Oliver Your Availity training team is committed to helping

www.availity.com 1

JUNE | JULY 2012

inFocusNewsletter for users of the Availity® Health Information Network

Find out the answers

to the questions you

always wondered, but

never had time to ask.

LOG IN • REGISTER • AVAILITY.COM

Tell us what you think— email us at [email protected]

News Events Training

Goodquestion

Page 2: inFocus - Availity4 Availity inFocus | June/July 2012 Good habit, bad habit Best practices in using Availity By Kristina Oliver Your Availity training team is committed to helping

CONTENTS

Good question Find out the answers to the questions you always wondered, but never had time to ask.

We’ve narrowed your questions about Availity

down to your top five most frequently asked,

because who has time to read more than that?

Good habit, bad habit Best practices in using Availity

Availity’s director of learning and documentation

services, Kristina Oliver, shares tips to improving your

productivity with Availity.

Spotlight on Availity’s Health Care Business Expert Series

Trust Availity for up-to-the minute education from

industry experts on topics that matter to your work life

Case Files

What’s New?

Training

Events

Crossword

1

4

56

7

8

9

10

CareCost Estimator and Remit Reader are service marks (SM) of Availity, LLC.

CareCollect, CareProfile, CarePrescribe and CareRead, are registered trademarks (®) of Availity, LLC.

CareCalc is a registered trademark of Florida Blue.

ContactFor newsletter suggestions: [email protected] customer support: 1.800.AVAILITY (282.4548) P.O. Box 550857 Jacksonville, FL 32255-0857

Availity inFocus, June/July 2012

Page 3: inFocus - Availity4 Availity inFocus | June/July 2012 Good habit, bad habit Best practices in using Availity By Kristina Oliver Your Availity training team is committed to helping

www.availity.com 1

Good questionFind out the answers to the questions you always wondered, but never had time to ask

Sometimes there just aren’t enough hours in the day. You’re busy tackling all the tasks of managing an office, from phones to billing to serving patients. And sometimes, that just doesn’t leave much time for anything else—like webinars or other training that can help you optimize your workflow.

So we’ve made it easier to get the answers to questions you may have, but don’t have time to ask. We’ve narrowed your questions about Availity down to your top five most frequently asked, because who has time to read more than that?

Availity displays information and

messages as the payer sends them.

Some health plans have multiple

systems in which patient and claim

information is stored. While the

health plan’s customer service center

has access to all of these systems,

the health plan may be sending data

to Availity from only one or a few of

their systems, not all of them.

Availity and our partner health plans

understand how frustrating these

discrepancies can be for our users,

and both we and they are continually

working to make sure that the

information presented on Availity is

the best available from the payer. If

the results are unclear, confusing, or

incomplete, you may contact Availity

Client Services, but we will probably

need to refer you to the health plan

for further assistance. While you’re

on the phone with the health plan,

be sure to express your interest in

having them send information from all

patient and claim systems to Availity.

continued on page 2

1 Why does the information I get in Availity sometimes differ from the information I get on the phone with the payer (especially for claim status and eligibility & benefits)?

Page 4: inFocus - Availity4 Availity inFocus | June/July 2012 Good habit, bad habit Best practices in using Availity By Kristina Oliver Your Availity training team is committed to helping

2 Availity inFocus | June/July 2012

How do I change my password?

2

Availity has made it easier than ever

for you to self-manage your access.

Rather than having to call Availity to

reset your password, you can now do

that instantly from the login page using

your email address. Just click Help!

I can’t log in. Follow the prompts

to enter your user ID, answer your

security question and create a new

password instantly.

To take advantage of this benefit,

you’ll need to use an individual,

non-shared email address to access

Availity. You can update your email

address at any time in the portal by

clicking My Account | My Profile and

clicking Change User Information.

You should make this important

update to your account today, as

Availity has recently discontinued

operator-assisted phone support for

common password reset issues.

If you’d like to change your password

while logged into Availity, click My

Account | My Profile. On the My

Profile page, click Change Password

and follow the prompts.

The reason for a particular rejection

depends on many factors, and it is

important to distinguish among the

types of responses such as notification

files, acknowledgements and reports

so that you can appropriately respond

to these rejections.

Availity has a number of valuable

learning resources to help you

understand the different types of

rejections. The following documents

contain the error message, cause and

tips for troubleshooting:

• Interpreting FAILED

Notification Files (in SendFiles

Mail Box)

• Interpreting File

Acknowledgements

• Interpreting Interchange

Acknowledgement Files

• Interpreting Functional

Group or Implementation

Acknowledgement Data Files

• Interpreting IBR Files

• Interpreting EBR Files

• Interpreting DPR Files

continued on page 3

Why was my EDI transmission file rejected?

3

Page 5: inFocus - Availity4 Availity inFocus | June/July 2012 Good habit, bad habit Best practices in using Availity By Kristina Oliver Your Availity training team is committed to helping

www.availity.com 3

What should I do when I get locked out of the system?

4

Access to Availity may be locked for a

number of reasons, including:

• Fiveormoreconsecutive

incorrect responses to your

security question.

• Ithasbeenoneyearormore

since your last login.

• YourPrimaryAccess

Administrator (PAA) has revoked

your account. This typically

occurs if you left the organization

for a significant period of time.

• Youraccountisnotcurrently

associated with an active

organization.

How can I view remittance information on Availity?

Remit ReaderSM is a new tool from

Availity that enables you to view,

search, and reconcile your electronic

remittance advice. Using Remit

Reader, you can search for ERA

information by check, patient or

claim information. When searching

for ERA information, you can search

all payers or a specific payer.

Remit Reader is available to:

• Providerswhoareenrolledfor

ERA delivery through Availity.

• Billingserviceswhoreceive

ERA files on behalf of providers.

• ProviderswhoseERAfilesare

stored with Availity.

• Providerswhohavebeen

granted access to another

organization’s ERAs.

To access this feature, click Claims

Management | Remit Reader

from the Availity menu. If this menu

item does not display, you may not

be assigned the Claims Status role.

Contact your PAA and request that

the Claim Status role be added to

your access.

For additional tips on getting started

with Remit Reader, go to availity.

com/remits. And be sure to check

out Availity’s free training on this

topic, including the on-demand

Remittance Solutions and Claims

Follow-up webinar.

5

What to do if you are locked out

Contact your PAA for assistance if

you are locked out of the system.

He or she can reset your access.

!

Page 6: inFocus - Availity4 Availity inFocus | June/July 2012 Good habit, bad habit Best practices in using Availity By Kristina Oliver Your Availity training team is committed to helping

4 Availity inFocus | June/July 2012

Good habit, bad habit Best practices in using Availity

By Kristina Oliver

Your Availity training team is committed

to helping you get the most out of

Availity. That’s why we offer a variety of

free learning options, from on-demand

webinars to online demonstrations to

tips sheets and more.

Short on time? That’s OK, too.

Becausenotallofourusershave

time for training, we’ve rounded up a

number of quick tips for you that you

can implement right away!

Making a few small changes and

turning them into a part of your

regular workflow can help you use

Availity more efficiently, reduce

errors and improve your productivity.

So follow these helpful guidelines

when using Availity.

Reduce typingPrevent data-entry errors and use the Express

Entry field to automatically populate provider

information in provider-related fields. Any user can

use the Manage Providers feature to set up Express

Entry. Have a few minutes now? Check out our short,

interactive demos to learn more!

Breeze through the formsSpeed up data entry by not switching between keyboard

and mouse: most forms are set up to allow you to use

only the keyboard to enter data. To see all data

fields, make sure to complete the fields in the order

they appear on the page. Many menu-like fields cannot

display options until you complete the preceding fields.

For example, because the options in the Type of Benefits

RequestedfieldontheEligibilityandBenefitsInquiry

page are payer-specific, they do not display until you

complete the Payer and Organization fields.

Eliminate reworkWhen you need to submit a claim,

inquire about a claim status, or request

for authorization or referral, verify the

patient’s eligibility and benefits (E&B)

first. From the E&B result, go immediately

to the other form. Availity carries over the

payer and patient information from the E&B

results to the new form and automatically

populates the appropriate fields.

This feature helps ensure the data is current

and accurate when you submit the new

transaction, increasing the likelihood that

it will be free of errors and accepted and

approved at the payer. In addition, verifying

E&B each time a patient visits your office

ensures that you collect the correct amount

of copayments, deductibles, and out-of-

pocket expenses at the time of service.

Page 7: inFocus - Availity4 Availity inFocus | June/July 2012 Good habit, bad habit Best practices in using Availity By Kristina Oliver Your Availity training team is committed to helping

www.availity.com 5

Availity’s Health Care Business Expert

Series delivers continuing education

presented by national experts on

health information technology. Trust

Availity for up-to-the minute education

from industry experts on topics that

matter to your work life, such as ICD-

10, best practices in revenue cycle

management, and using technology

to manage your workflow.

• Broadenyourskillsortrainfor

expanding job responsibilities.

• Improvetheperformanceofyour

practice.

• Fulfillcontinuingeducation

requirements.

Webinars are $129 each and

attendeesreceiveacertificateof

completion and continuing education

units, where applicable. To register

and enroll in a webinar, visit the

Availity Learning Center.

Don’t miss out! Previous webinars

have featured Elizabeth Woodcock on

Revenue Cycle Management: Your

Roadmap to Success, Robert Tennant

on Understanding and Implementing

ICD-10 in Physician Practices and

Rosemarie Nelson on Optimizing Your

Clinical Workflow with Technology.

Spotlight on: Availity’s Health Care Business Expert Series

On Demand

Recorded versions of past

webinars are always available,

allowing you to view them when

it’s convenient for you. Just

log into the Availity Learning

Center to view a list of recorded

webinars available for purchase.

Coming soon!Karen Zupko

Boost Patient Payments: Give Your Systems a Checkup

Register today

When it comes to collecting from

patients, if your people and processes

are not functioning in high gear,

accounts receivables soar and your

overhead percentage increases. In

this live webinar with industry expert

Karen Zupko, learn how to create an

action plan to reduce patient debt and

boost your bottom line.

Learn how to:

• Evaluateyourcurrentpoint-of-

service collection results,

• Implementsystemschangesthat

improve your bottom line,

• Trainstafftobetterhelppatients

make and keep payment plans,

• Assesspatientswhocan’tpay,and

• Implementup-to-the-minute

payment technologies.

Thurs.,July 26

12:00 EST$129

Page 8: inFocus - Availity4 Availity inFocus | June/July 2012 Good habit, bad habit Best practices in using Availity By Kristina Oliver Your Availity training team is committed to helping

6 Availity inFocus | June/July 2012

CASE FILES

Just like the children they serve, the

staff at Pediatric and Adolescent

Associates never slows down. The

Lexington, Ken. office stays open

364 days a year, and with some 300

patients a day coming through its

doors, the team frequently works well

into the evening.

“We want to keep patients out of

the emergency rooms, and often

times that means staying late to

serve them,” said Martina Denny, an

office administrator.

The five office staff were so busy

serving patients for 11 doctors that

they didn’t have any time to spare

to verify eligibility and benefits. The

staff already spent hours a day on

the phone to inquire about claim

status and precertification—a time-

consuming and frustrating process

that involved long call hold times,

disconnected phone calls and

transfers to other representatives

or departments. So they relied

on patients to give them accurate

information about their benefits.

“We just didn’t feel like we had the

resources to check eligibility and

benefits on a regular basis,” Denny

said. “We’d have timely filing issues

and claim denials, and we’d have

to chase patients down for current

insurance information. It was causing

a lot of problems.”

When the staff heard about Availity

through the local physician’s society,

they decided to give it a try. Denny

was immediately impressed with how

quick and simple Availity was to use.

After initially using Availity for just

claim status and denials research, the

staff found it could use Availity for

a variety of other tasks to save time

and streamline their workflow. Today,

Pediatric and Adolescent Associates

uses Availity for submitting questions

to health plans, submitting claims and

securing prior authorizations.

Denny said the office staff has used

all the time savings to finally check

eligibility and benefits. Doing so has

produced even more savings, cutting

down on time spent correcting claims

with inaccurate benefits information.

She said that she’s increasingly

relying on Availity for accurate

information—sometimes more

current than information provided by

the health plan!

“It’s just so easy with Availity, so

we’re using Availity for more and

more,” Denny said. “The time

savings has been a huge benefit.

Availity offers easy access to claim

status information for several

insurance companies, which allows

our staff to spend their time in more

productive ways.”

Pediatric office allocates saved time to check eligibility and benefits

“We’re using Availity for more and more...the time savings has been a huge benefit.”

Martina Denny | Pediatric and Adolescent Associates

Has Availity helped your practice?

We want to hear from you! Send us

your story and you may be featured

in a future “Case Files” story. Email

us at [email protected].

Page 9: inFocus - Availity4 Availity inFocus | June/July 2012 Good habit, bad habit Best practices in using Availity By Kristina Oliver Your Availity training team is committed to helping

www.availity.com 7

Enhancement and update news from AvailityWHAT'S NEW

Changes coming to Blue Cross and Blue Shield of Minnesota PWSS/Provider Hub BlueCrossandBlueShieldof

Minnesota is transitioning Clear

Connect functionality from PWSS/

Provider Hub to Availity, effective July 1.

BlueCrossandBlueShieldof

Minnesota first partnered with

Availity in August 2009 and is

extending that relationship now as

it complies with the HIPAA version

5010 transaction standard.

As a result of this transition, you

can streamline your workflow by

conducting more of your transactions

withBlueCrossandBlueShieldof

Minnesota and other health plans

through Availity.

New to Availity?

Availity makes it a snap to get started

withavarietyoftrainingoptions.Be

sure to check the Training section of

this newsletter for a list of upcoming

webinars and workshops, or you can

always check Free Training in the

Availity portal for a comprehensive list

of live and on-demand webinars, online

demonstrations, tip sheets and more.

Workers’ compensation claims now available on the Availity portal In an ongoing effort to provide

you with greater value through

expanded services, Availity is

pleased to announce that workers’

compensation claims can now be

submitted to more than 450 health

plans via the Availity portal. With this

expansion, you can now:

• Submitworkers’compensation

claims(eBills)throughAvaility,

via EDI.

• ReceivestandardAvailityreports,

attachment request fax cover

sheets and notifications, and

electronic remittance advice.

• Search,view,andreconcileERAs

through Remit Reader.

To access workers’ compensation

features, click Claims Management

| Professional Claim or Claims

Management | Facility Claim in

the Availity menu. In the Payer field,

select Workers’ Compensation, then

click Workers’ Compensation Payer.

In the Workers’ Compensation

Payer field, select the specific payer

to which you are submitting the claim.

Complete the claim form as

appropriate. If an attachment

is required for the claim, a fax

coversheet will be made available in

your Availity Receive Files mailbox.

What’s New continues on page 8

If you currently use the PWSS/Provider Hub to verify eligibility and benefits and/or claim status for out of state Blue Cross and Blue Shield of Minnesota members, you will be able to conduct those transactions only through Availity for out of state members, effective July 1.

!

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8 Availity inFocus | June/July 2012

TR

AIN

ING Learn more about Availity

To register for any of these upcoming webinars, just click the Free

Training tab at the top of any page in the Availity portal. All times are

Eastern Standard.

June 26 2:30 PM User Training for Anthem BCBS Providers

June 27 2:30 PM CareCollect Payment Processing

July 10 10:30 AM CareCollect Payment Processing

July 11 2:30 PM Web Data Entry Claim Submission

July 13 10:30 AM User Training for Anthem BCBS Providers

July 13 2:30 PM CareProfile® and Clinical Messaging

July 16 2:00 PM CareCost EstimatorSM for Blue Cross and Blue Shield Providers in Texas, New Mexico, Oklahoma and Illinois

July 17 1:30 PM Primary Access Administrator Training

July 20 10:30 AM EDI Training for EDI Submitters

July 24 2:30 PM User Training for Anthem BCBS Providers

July 25 2:30 PM Remittance Solutions and Claims Follow-up

July 26 1:00 PM Eligibility, Benefits and CareCalc for Florida Providers

We’re adding new webinars

every day, so be sure to check

the Availity portal for a complete

listing of upcoming training

events. Just click Free Training in

the Availity portal.

P Additional payers available for

Web transactions

P Expanded availability of Availity®

CareCost EstimatorSM for Cigna

P Certificate of Coverage Booklet

now available for Anthem

members

P Enhanced authorization and

referral service types for Florida Blue

P Enhanced printing for Remit Reader

P Clinical messaging now available from

Humana

P Authorization and Referral

enhancement

P New field for workers’ compensation

claims

Updates: Quick Hits

For complete updates on Availity enhancements, please review our release communications

MAY JUNE

Page 11: inFocus - Availity4 Availity inFocus | June/July 2012 Good habit, bad habit Best practices in using Availity By Kristina Oliver Your Availity training team is committed to helping

www.availity.com 9

EVENTS Stop by our booth and say "hello" at one of these upcoming events.

July 13 Northland Medical Managers 1202 Annual Symposium Kansas City, MO

July 18 Adventist Health System Revenue Cycle Conference Champions Gate, FL

July 25Minnesota Medical Group Management Association’s

Summer ConferenceAlexandria, MN

July 27 Florida Medical Association’s Annual Meeting Boca Raton, FL

Your FastestPath to Payment

© 2012 RealMed Corporation. All rights reserved.

www.realmed.com

Health care providers turn to RealMed, a complete revenue cycle management solution, when they want real results:

•Fastercashflow and fewer days in accounts receivable.•Automatedeligibilitychecking during claim submission.•Improvedoperationalefficiency including fewer claim errors and fewer denials.•Betterunderstandingofworkflowpatterns, to help you maximize revenue.

Click to learn how Asheville Anesthesia Associates SAVED

in time-to-payment!75%

Page 12: inFocus - Availity4 Availity inFocus | June/July 2012 Good habit, bad habit Best practices in using Availity By Kristina Oliver Your Availity training team is committed to helping

10 Availity inFocus | June/July 2012

Across4. Recommended before starting any recreational or sports activity5. Helps providers reconcile accounts receivable more quickly and easily9. Traditional June birthstone12. City where the Declaration of Independence was signed13. The host city of the Summer Olympics14. Trained professional for water-related safety15. Lifesaving technique used for drowning rescues17. A popular savings tool for members with high deductible medical plans19. Administrative workflows in a practice that impact the ability to get paid

for services rendered22. Cool people eat this Great American Dessert23. Helps providers quickly collect the correct payment while patient is

still present25. Considered “safe” fireworks, but still contribute to burn-related injuries

Down1. Students go here for extended academic study2. One of two sports eliminated after the 2008 Beijing Games3. Popular summer fruit6. Traditional sleep-away program for youth7. Generic identifier used on Credit Reports for outstanding medical

expenses8. Plant commonly used to soothe sunburned skin10. Amount the insured member is responsible for paying11. Sending of a payment from one place to another16. Popular summer vacation destination for families18. National Pickle Month20. Host city of the only Olympic Games where the U.S. did not compete21. Family member honored in June24. A medical record in a digital format is known by this acronym

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CROSSWORD Dollars and Sense—Practice, Payments and More

Solution March 2012