Availity enrollment

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Some services can be auto-approved based on the provider's TIN or service s and diagnosis es being requested. In this case you won't be required to provide additional information. For the Authorization Inquiry page, how long does it take for a prior authorization completed by phone or fax to be loaded?

We don't take prior authorizations by phone. The speed of loading a faxed request completely depends on the volume of faxes received. Submitting online through Availity gives you a faster response. You can upload handwritten notes as a. PDF and attach it to your request. We can accept all types of files, including doc, docx, gif, htm, jpg, pdf, png, ppt, pptx, tif, txt, xls or xlsx.

Call Care Management at , option 3 AK: , option 3. On the code check feature if a code requires review, but doesn't need it in certain situations i. The tool will do auto authorizations based on a specific code and diagnosis being submitted.

As for stopping them, the prior authorization process flow won't stop the requester. Does the code check tool provide member-specific benefit information for prior authorizations? The stand-alone code check tool doesn't provide member-specific benefit information see screenshot below.

The prior authorization checks to see if a code requires prior authorization and does include member-specific benefit information about the member's referral requirements and out-of-network benefits. I work at a residential substance abuse facility. We use ICD codes, not procedure codes. How does that work in Availity? This would be an inpatient prior authorization request and we would accept ICD diagnosis codes.

What happens if you have more than three diagnosis codes? Currently, the Availity tool only accepts 3 diagnosis codes. If you have more than three, you can include the additional diagnosis codes in the Provider Notes section.

What if I don't have a procedure code to add to my request? For inpatient notification requests, you don't need to add a procedure code. There will not be one for Lower Level of Care admissions. Can I submit a Premera PCP referral request to a specialist on Availity or is it only for prior authorization requests?

At this time, it's for prior authorizations only. Providers can only submit prior authorizations through Availity for Premera plans. We're not using Availity for PCP referrals yet.

Does this replace referral authorization submissions via Premera's current secure portal for Premera Medicare Advantage? Premera Medicare Advantage continues to use Advantasure. Can I submit a referral through Availity for Amazon and Microsoft patients?

No, we're not currently submitting referrals through Availity. Can this be used for retroactive prior authorization submissions? Prior authorization needs to happen before the service is performed; after that you would submit a claim. What about Evolent and Advantasure secure tools? Providers will continue to use OneHealthPort's secure single sign-on process to access Evolent, Advantasure, Availity, and other health plan provider portals.

If requesting services through Availity, you'll be directed to complete the request through AIM or eviCore. Do I submit prior authorizations through Availity for high-tech imaging? Can we submit through Availity instead, or do we still need to submit through eviCore? If you submit your requests through eviCore today, you'll continue to submit through eviCore.

Do prior authorizations for individual plans go through Availity now? No, you will need to continue to go through Evolent secure portal for individual plans. Does everyone have access to AIM? It's not listed on my account. AIM is a third-party vendor for certain types of services. If a service is required to be completed by AIM, you'll be directed by the health plan payer to complete your request through AIM.

The process flow for prior authorizations includes a check to see if a code requires prior authorization before completing a request. The requester can't move forward with completing the request through Availity. Does this mean we no longer go through eviCore for any Premera Blue Cross members?

Prior authorization service requests that go through eviCore today will continue to go through eviCore. Once a case is processed, can you view the denial letter on the portal, or at least the reason for denial criteria? No, not at this time. It will give you a denial and a denial reason and you'll get a separate letter with the denial details. If a prior authorization request is denied, is the denial letter available in Availity?

The denial letter is sent directly to the member and the requesting provider. Will Availity provide a denial reason? Yes, but Availity only provides a high-level denial reason. The denial letter provides complete details. Are the denial and approval letters faxed? Yes, the letters are faxed to the requesting provider. When a prior authorization is denied, is there an option to appeal through Availity such as a peer-to-peer review or a phone number to call? Not at this time.

Details about appeals are in the denial letters. Can we appeal through Availity? Premera requires a signed member authorization for all appeals submitted on the member's behalf. The member appeal form includes an authorization section for the member to sign and date.

Providers need to coordinate the submission of appeals with the member as the signed member appeal form must be included with any supporting documentation or medical records relevant to the appeal. Appeals related to contracted rates or provider payments aren't member appeals and don't require member authorization. OHP remains as our gateway vendor for single sign-on activity. Instead of signing in repeatedly to multiple health plan portals, OHP users sign in just once and get secure authentication for many health plans.

We'll continue to use OHP for single sign on authentication. Premera's secure provider tools will transition to Availity starting September Register and get training. How do I get more Availity training? That will open the Availity Learning Center. You can also contact Training Availity. If I have technical issues with Availity, who do I call? What if we try to set up an Availity account and find that one already exists?

Does it provide the administrator's name? For security purposes, no, it doesn't give the administrator's name. For OneHealthPort account or log-in questions, call Will we receive an error message or be guided to contact the health plan? If you receive an error message while using the Availity tools, please reach out to Availity Client Services at , Monday through Friday, 8 a. What's the difference between Availity and Availity Essentials? They're essentially the same.

Availity, LLC. Availity Essentials the new name of the secure tool portal where you can work electronically with multiple payers through a variety of applications. Are there ever updates to the Availity portal that I may have missed? I log in and out all the time. We have a major release the third Saturday of every month, except November and December.

The releases occur on the second weekend of the month. Does Availity show if the member is on a plan or a calendar year?

Benefits could change due to open enrollment periods. Each time the user checks benefits, it does a real-time inquiry which is why we must pull in the date the benefits are verified the as-of date. The provider can check benefits using a specific date. If the payer returns information about the coverage period, the information displays:.

If you communicate with national DME providers who may already be using Availity, you could let them know that Premera has now partnered with Availity. If they're signed up with Availity, they can check eligibility and benefits and submit claims. Is One View Population Health going away? If you have access to this platform, you can continue to use it just as you normally do.

How Availity Essentials supports your practice Sign in to access information, tools and resources that support the day-to-day needs of your patients and office. Coverage and preauthorizations View patient eligibility and benefits Submit or manage preauthorizations and referrals View Humana member ID cards.

Claims Submit claims Review claim statuses Submit requested medical record s Dispute or appeal finalized claims. Billing and payments View or download remittance documents Manage overpayments Sign up for electronic payments and remittance documents.

Get started with Availity Essentials. If your organization already uses the portal Contact your Availity administrator to request a username.

Attend an educational webinar. Other webinar topics include: Checking eligibility and benefits Submitting and managing referrals and authorizations Managing claims and payment information Submitting requested medical records Submitting disputes and appeals. View webinar schedule. Helpful resources. Find the information you need. Join our network.

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Providers who are not yet registered with Availity, can sign up today at Availity , at no charge. If you need registration assistance, contact Availity Client Services at Email our Provider Education Consultants. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals.

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