infocus - availity4 availity infocus | june/july 2012 good habit, bad habit best practices in using...
TRANSCRIPT
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
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
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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
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)?
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
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.
!
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.
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
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].
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.
!
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
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%
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