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Availity® Authorizations

Availity’s Authorizations tool (HIPAA-standard 278 transaction) allows the electronic submission of inpatient admissions and select outpatient services handled by BCBSMT. Additionally, providers can also check status on previously submitted requests and/or update applicable existing requests.

Benefits of using this online functionality:

  • No separate user enrollment needed
  • Direct access within Availity portal
  • Simplified 5-step process

How to access and use Availity Authorizations:

  1. Log in to Availity
  2. Select Patient Registration menu option, choose Authorizations & Referrals, then Authorizations
  3. Select Payer BCBSMT, then choose your organization
  4. Select a Request Type and start request
  5. Review and submit your request

For additional details, refer to the Availity Authorizations User GuidePDF Document.

Important Tips:

  • Check eligibility and benefits online first to determine if preauthorization is required for the service and/or procedure code(s). To learn more about checking eligibility and benefits via Availity, refer to the General Eligibility and Benefits Expanded tip sheetPDF Document.
  • Authorizations managed through eviCore healthcare (eviCore) will continue to be handled through the eviCore portal.
  • Predetermination requests must be sent by fax or mail using the appropriate form in the Forms and Documents section.

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 800-282-4548.

Questions?

Email our Provider Education Consultants. Be sure to include your name, direct contact information, Tax ID and/or Billing NPI.

Sours: https://www.bcbsmt.com/provider/education-and-reference/availity-authorizations

Many of the tools you need — such as eligibility and benefits inquiry, claims submission, claims status inquiry, and authorizations — can now be accessed by logging into the Availity Portal*.

Don’t have an Availity account?

Register free now

* Availity, LLC is an independent company providing administrative support services on behalf of UniCare Health Plan of West Virginia, Inc.

Find these tools on Availity

Expand the options below for instruction on locating each tool.

To submit a claim:

  1. From the Availity home page, choose Claims & Payments from the top navigation.
  2. Select Type of claim from the drop-down menu.
  1. From the Availity home page, select Claims & Payments from the top navigation.
  2. Select Claim Status Inquiry from the drop-down menu.
Claims status inquiry and claim dispute

To check claims status or dispute a claim:

  1. From the Availity home page, select Claims & Payments from the top navigation.
  2. Select Claim Status Inquiry from the drop-down menu.
  3. Submit an inquiry and review the Claims Status Detail page.
  4. If the claim is denied or final, there will be an option to dispute the claim. Select Dispute the Claim to begin the process. You’ll be redirected to the Payer site to complete the submission.

To use Clear Claims Connection:

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the appropriate health plan.
  3. From the payer spaces home page, select the Applications tab.
  4. Select the Clear Claims Connection tile.

To request authorizations:

  1. From the Availity home page, select Patient Registration from the top navigation.
  2. Select Auth/Referral Inquiry or Authorizations.
Prior authorization lookup tool

To check if authorization is required:

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the appropriate health plan.
  3. From the payer spaces home page, select the Applications tab.
  4. Select the Prior Authorization Lookup Tool.
Eligibility and benefits inquiry

To check member eligibility and benefits:

  1. From the Availity home page, select Patient Registration from the top navigation.
  2. Select Eligibility and Benefits Inquiry.

Note: There’s a separate registration your organization’s administrator needs to complete to access this tool. Please see registration instructions in the Registration for provider online reporting section below.

To access member panel listings:

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the appropriate health plan.
  3. From the Payer Spaces home page, select the Resources tab.
  4. From the Resources tab, select Provider Online Reporting. If you don't see it on the list, select Next from the right-hand side at the bottom of the page.
  5. From the Provider Online Reporting page, select Member Panel Listings.

Note: There is a separate registration that your organization’s administrator needs to complete to access this tool. Please see registration instructions in the "Registration for provider online reporting" section below.

To access member reports:

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the appropriate health plan.
  3. From the Payer Spaces home page, select the Resources tab.
  4. From the Resources tab, select Provider Online Reporting. If you don’t see it in the list, select Next from the right-hand side at the bottom of the page.
  5. From the Provider Online Reporting page, select Member Reports.
Registration for Provider Online Reporting

Note: Your organization's administrator must complete this registration process and grant access to users in the organization.

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the appropriate health plan.
  3. From the Payer Spaces home page, select the Resources tab.
  4. From the Resources tab, select Provider Online Reporting. If it is not shown in the list, select Next from the right-hand side at the bottom of the page.
  5. Select I Agree on the Disclaimer page.

You will then be redirected and see the message, "Welcome to provider online reporting."

  1. Select Register/Maintain Organization to register your organization’s tax ID to the applicable program.
  2. Select Register Tax ID to register for the eligible program (member reports or panel listings).
  3. Select Maintain User/Register User to grant access to users.
  4. Complete all fields on the Register User page. Select ADD TO PREVIEW and Save.
  5. Go to Report Search, select the program, complete the required fields and select Search.
  6. A file should now be available.

To access provider online reporting for all users once registration is completed:

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the appropriate health plan.
  3. From the Payer Spaces home page, select the Resources tab.
  4. From the Resources tab, select Provider Online Reporting.
  5. Select I Agree on the Disclaimer page.
  6. Go to Report Search, select the program, complete the required fields and select Search.
  7. A file should now be available.

To access Patient360:

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the appropriate health plan.
  3. From the Payer Spaces home page, select the Applications tab.
  4. Select the Patient360 tile.

Provider tools & resources

Interested in becoming a provider in the UniCare network?

We look forward to working with you to provide quality services to our members.

Sours: https://www.provider.unicare.com
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Learn about Availity


Did you know Availity simplifies provider transactions such as HIPAA, administrative and clinical data exchange, and payer tools? Availity’s secure multi-health plan portal gives you easy access to health plan information.

Don’t have an Availity account?

Start using Availity now!

To register your organization, visit Availity and select Register

Already registered?

If you need further assistance, please call Availity Client Services at 1-800-AVAILITY (1-800-282-4548).

Availity organization and maintenance

To change administrators:

  • Please call Availity Client Services at 1-800-AVAILITY (282-4548), Monday to Friday.

To update organization information, if you’re an administrator:

  • Log in and use the Maintain Organization feature.

You’ll be able to change your organization's address, phone number, tax ID and NPI. Any changes made will automatically apply to all Availity users.

Availity offers:

Patient registration

  • Get real-time patient eligibility and benefits, including current and historical coverage information, plus detailed coinsurance, copay, and deductible information.
  • Submit secure, online authorizations or check the status of existing ones with our Interactive Care Reviewer (ICR).

Prior authorizations

ICR is our innovative utilization management (UM) feature that allows you to:

  • Submit prior authorization requests, clinical information and receive status updates without having to pick up a phone or fax any information.
  • Have instant access to all submission records from any location at any time of day.
  • Create and submit UM prior authorization cases quickly by attaching clinical documents for review.
  • Automatically authorize more than 40 common procedures.

Claims and payment:

  • Find everything you need to take care of your patient’s needs, including claim submissions, detailed payment information, and claim payment disputes and appeals.
  • Submit your medical records electronically when requested to support a pending or denied claim, including an itemized bill and requested medical records.

Payer Spaces applications:

  • Research procedure code edits and receive edit rationale with Clear Claim Connection.
  • Access job aids, reference guides and educational videos through Custom Learning Center.
  • Locate important policies and forms in the Education and Reference Center.
  • View images of Amerigroup Community Care of New Mexico, Inc. paper remits from the past 24 months in Remittance Inquiry.
  • Get a thorough snapshot of your patient’s health and treatment history that now includes gaps in care and care reminders with Patient360.
  • Access your proprietary reports such as member rosters in Provider Online Reporting.

Provider Tools and Resources

Interested in becoming a provider in our network?

We look forward to working with you to provide quality services to our members.

Sours: https://provider.amerigroup.com

Learn about Availity

Many of the tools you need — such as eligibility and benefits inquiry, claims submission, claims status inquiry, and authorizations — can now be accessed by logging into the Availity Portal.

Find these tools on Availity

Expand the options below for instruction on locating each tool.

To submit a claim:

  1. From the Availity home page, choose Claims & Payments from the top navigation.
  2. Select Type of claim from the drop-down menu.

To check the status of a claim:

  1. From the Availity home page, select Claims & Payments from the top navigation.
  2. Select Claim Status from the drop-down menu.
Claims status inquiry and claim dispute

To check claims status or dispute a claim:

  1. From the Availity home page, select Claims & Payments from the top navigation.
  2. Select Claim Status from the drop-down menu.
  3. Submit an inquiry and review the Claims Status Detail page.
  4. If the claim is denied or final, there will be an option to dispute the claim. Select Dispute Claim to begin the process. You will be redirected to the payer site to complete the submission.

To use Clear Claims Connection:

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the appropriate health plan tile.
  3. From the payer spaces home page, select the Applications tab.
  4. Select the Clear Claims Connection application.

To request authorizations:

  1. From the Availity home page, select Patient Registration from the top navigation.
  2. Select Authorizations and Referrals.
  3. Select Auth/Referral Inquiry or Authorizations.
Prior authorization lookup tool

To check if authorization is required:

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the appropriate health plan tile.
  3. From the payer spaces home page, select the Applications tab.
  4. Select the Prior Authorization Lookup Tool.
Eligibility and benefits inquiry

To check member eligibility and benefits:

  1. From the Availity home page, select Patient Registration from the top navigation.
  2. Select Eligibility and Benefits Inquiry.

Note: There’s a separate registration your organization’s administrator needs to complete to access this tool. Please see registration instructions in the "Registration for provider online reporting" section below.

To access member panel listings:

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the appropriate health plan tile.
  3. From the Payer Spaces home page, select the Resources tab.
  4. From the Resources tab, select Provider Online Reporting. If you do not see it on the list, select Next from the right-hand side at the bottom of the page.
  5. From the Provider Online Reporting page, select Member Panel Listings.

Note: There is a separate registration that your organization’s administrator needs to complete to access this tool. Please see registration instructions in the "Registration for provider online reporting" section below.

To access member reports:

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the appropriate health plan tile.
  3. From the Payer Spaces home page, select the Resources tab.
  4. From the Resources tab, select Provider Online Reporting. If you do not see it in the list, select Next from the right-hand side at the bottom of the page.
  5. From the Provider Online Reporting page, select Member Reports.
Registration for provider online reporting

Note: Your organization's administrator must complete this registration process and grant access to users in the organization.

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the appropriate health plan tile.
  3. From the Payer Spaces home page, select the Resources tab.
  4. From the Resources tab, select Provider Online Reporting. If it is not shown in the list, select Next from the right-hand side at the bottom of the page.
  5. Select I Agree on the Disclaimer page.

You will then be redirected and see the message, "Welcome to provider online reporting."

  1. Select Register/Maintain Organization to register your organization’s tax ID to the applicable program.
  2. Select Register Tax ID to register for the eligible program (member reports or panel listings).
  3. Select Maintain User/Register User to grant access to users.
  4. Complete all fields on the Register User page. Select ADD TO PREVIEW and Save.
  5. Go to Report Search, select the program, complete the required fields and select Search.
  6. A file should now be available.

To access provider online reporting for all users once registration is completed:

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the appropriate health plan tile.
  3. From the Payer Spaces home page, select the Resources tab.
  4. From the Resources tab, select Provider Online Reporting.
  5. Select I Agree on the Disclaimer page.
  6. Go to Report Search, select the program, complete the required fields and select Search.
  7. A file should now be available.

To access Patient360:

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the appropriate health plan tile.
  3. From the Payer Spaces home page, select the Applications tab.
  4. Select the Patient360 application.

Provider tools & resources

Interested in becoming a provider in our network?

We look forward to working with you to provide quality service for our members.

Sours: https://provider.amerigroup.com

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