Welcome
Availity Customer Connection 2011
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©2011 Availity, LLC | All Rights Reserved
Agenda
Topic
Time
Registration, continental breakfast, and exhibit booth visitation
8:00 am – 8:30 am
General introduction (Availity background, registration, PAA responsibilities)
8:30 am – 9:30 am
CareRead®, eligibility and benefits, and pre-certifications (authorizations/referrals)
Break and exhibit booth visitation
10:30 am – 10:45 am
Claim follow-up (claim status, remittance, and review)
10:45 am – 12:00 pm
Lunch and exhibit booth visitation
12:00 pm – 1:00 pm
CareCollect® (payment collection) and CareProfile® (health record information)
1:00 pm – 2:00 pm
Break and exhibit booth visitation
2:00 pm – 2:15 pm
RealMed® revenue cycle management (claim tracking, edit error management,
patient statements)
2:15 pm – 2:45 pm
Claims and EDI file management (web-entered claims, EDI submission, EDI reports)
2:45 pm – 4:00 pm
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9:30 am – 10:30 am
We want these sessions to be interactive, so please ask questions.
Availity and RealMed representatives are wearing branded shirts.
Please turn in your evaluation at the end of the day so we can continue
to improve these conferences!
©2011 Availity, LLC | All Rights Reserved
Sponsors and Exhibitors
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©2011 Availity, LLC | All Rights Reserved
Availity Background
Formation
• Joint venture between Blue Cross and Blue Shield of
Florida and Humana in 2001
• Partnered with THIN in 2006 and RealMed in 2010
Ownership
• BCBSF, BCBSMN, Health Care Service Corporation
(HCSC), Humana, WellPoint (Anthem)
• Service multiple health plans (~1,300)
Services
Goals
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• Availity supports a federated, real-time model
• Offer no charge basic and optional premium services
• Integrate with practice and hospital systems
• Streamline your workflow
• Reduce your costs
• Improve your patient relationships
©2011 Availity, LLC | All Rights Reserved
Availity Basic Solutions
Business Solutions
Health plan-sponsored tools—
offered at no cost to providers—
improve efficiency.
Batch/clearinghouse
• Claims
• Remittance Advice
Real-time
• Eligibility & Benefits
• Claim Status
• Referrals/Authorizations
• Claim Submission
Card swipe
• CareRead®
Patient responsibility
• CareCost EstimatorSM
Payment solution
• CareCollect®
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©2011 Availity, LLC | All Rights Reserved
Clinical Solutions
Clinical tools help support
collaborative programs for
improving patient care delivery and
quality outcomes.
Health record
• CareProfile®
Electronic prescribing
• CarePrescribe®
RealMed Premium Offering
Revenue Cycle
Management
Integrated and automated tools
enabling the highest degree of
performance optimization and self
service.
Providers who use RealMed:
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•
Make 10-12% fewer health plan
calls
•
Send up to 60% cleaner claims
to health plans
•
Send nearly 10% fewer paper
claims
©2011 Availity, LLC | All Rights Reserved
RealMed builds on the value offered
by Availity’s basic solutions by
bundling and automating multiple
functions that maximize operational
results.
RealMed is an integrated revenue
cycle management solution that
focuses exclusively on helping
practices improve the efficiency of
their revenue cycle processes and get
paid as quickly as possible.
Support for National HIT Objectives
• Security and privacy
• Compliance – HIPAA, CORE, EHNAC
• 5010 information available at
http://www.cms.gov/Versions5010andD0/40_Educational_Resources.asp
• Interoperability – Seamless integration with multiple systems
and stakeholders
• Meaningful use – Leverage widely available, consistent
administrative data
• Deliver quality – Real-time access to actionable, relevant
patient information at the point of care
• Eliminate cost – Identify fraud through medication history
access; save time by improving access to important
information
• Improve outcomes – Reduce avoidable adverse drug
events by providing alerts at the point of care
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©2011 Availity, LLC | All Rights Reserved
Terms to Know
Vendor, Technology Company Partner - A company that
creates computer systems that provider offices and hospitals use
to manage business, which may include billing, scheduling, and
other administrative tasks.
Payer, Receiver, Health Plan - The insurance company or
carrier responsible for paying providers and facilities for health
care services.
Implementation Guide - A document explaining the proper
use and structure of a standard for a specific business purpose.
Availity’s HIPAA validation is based on the ASC X12 4010A1
Implementation Guides and 5010 Technical Reports available
from the Washington Publishing Company.
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© Availity, LLC | All rights reserved.
Get Registered
• Go to www.availity.com.
• Click the Registration link.
• Complete online
application, print it, and
sign it.
• Fax it to Availity.
• A temporary password is
sent back to the Primary
Access Administrator
(PAA).
• Availity Client Services is
available at 800.AVAILITY
(282.4548).
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©2011 Availity, LLC | All Rights Reserved
Primary Access Administrator (PAA)
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•
•
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•
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Add users
Maintain users
Assist with registering for new products
Check for notices and updates
Assist with password resets
Maintain organization information
To locate contact information for your Primary Access
Administrator (PAA), log in to the Availity portal and click
Who control’s my access? from the top of any page. A
page displays containing your organization’s PAA and
Primary Controlling Authority (PCA) information.
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©2011 Availity, LLC | All Rights Reserved
Logging In and Out
First time
• Use temporary password
• Set up security questions and answers
• Set unique password
Ongoing
Forgot password options
View message alerts, if displayed
Reset password every 75 days
Review Home page information
For security purposes, log off when no
longer working in Availity
• Availity session times out after 30minutes of inactivity, with a 5-minute
alert to click Stay Active
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•
•
•
•
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©2011 Availity, LLC | All Rights Reserved
Availity Portal Navigation
When you log in, the Home page is displayed.
Training and
Resources – Links to
online demos,
training, lists, and
resources
Value-Added
Services – Links to
additional Availity
services
Enhancements –
Recent Availity
enhancements
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Announcements –
Announcements,
information, newsletters,
and more
©2011 Availity, LLC | All Rights Reserved
Downloads – Links
to download
necessary nocharge
applications
Availity Portal Top Navigation
Region displays if you are
registered in more than one state.
User name displays.
Home, Message Center, Help, and Log
Out are easily accessed. Be sure to log
out at the end of the session.
Click Who controls my access?
to locate the PAA and PCA for
your organization. A window
displays with the information.
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©2011 Availity, LLC | All Rights Reserved
Availity Portal Top Navigation
Availity Resources contains links
to My Availity Dashboard, My
Code Lists, the Availity EDI
Guide, registration forms, and
the Availity e-Focus newsletter
archive.
Click Free Training to
register for a webinar
and launch on-demand
webinars, if available.
Payer Resources contains payer-specific resources, such as payer
companion guides and user manuals, ERA/EFT application forms, and
provider directories. Each payer’s information displays on its own
page, making it easy to locate the information you need.
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©2011 Availity, LLC | All Rights Reserved
Availity Menu
• Click the menu categories
to expand the list of
options.
• The menus are based on
your unique ID and are
assigned by your PAA.
• Availity refers to the menu
categories as roles and
the menu option as
permissions.
• Click the menu option to
display the transaction.
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©2011 Availity, LLC | All Rights Reserved
Completing Inquiries and Submissions
• Select the payer first and
allow the page to refresh with
payer-specific field
requirements.
• Complete required fields,
typically marked with an
asterisk.
• Click Submit to submit for an
immediate real-time response.
• Click Add to Batch to add the
inquiry to a batch to be
submitted later for a real-time
batched response.
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©2011 Availity, LLC | All Rights Reserved
Electronic Information Exchange
• When you click Submit, Availity conducts HIPAA and other
front-end edits to validate the data you entered.
• Availity creates and sends an electronic transaction to the
health plan’s back-end system.
• The health plan receives the inquiry and responds
electronically.
• Availity passes the response as the payer returns it.
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©2011 Availity, LLC | All Rights Reserved
Viewing Response Results
• Availity displays the
information the health
plan returns in a
standard format.
• Use navigation on the
page to review and
print results, edit the
inquiry, and link to or
display additional
information.
• From a results page,
click another menu
option to persist data.
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© Availity, LLC | All rights reserved.
Availity Help
• Availity Help is accessible from any Availity page. Click Help in the
upper-right corner of the page.
• The help system displays in a separate browser window and is
context-sensitive, meaning Availity displays the topic for the page
you are viewing.
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©2011 Availity, LLC | All Rights Reserved
Availity Field Level Help
Field-level help offers quick information about individual fields.
Click a blue question mark (?) next to a field.
Availity displays a small, separate window with
field-specific help information.
Click the blue text for
field requirements
specific to that payer.
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©2011 Availity, LLC | All Rights Reserved
Availity Reports
• Transaction Logs
• Web transaction details over
a specific date range
• My Availity Dashboard
• Web and EDI acceptance
rates, error rates, etc.
• Helps identify trends
• Benchmark against all
Availity customers
• Top 10 EDI errors
• Web Transaction Reports
• Metrics by organization,
payer, and user
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©2011 Availity, LLC | All Rights Reserved
Availity Time-Saving Tips
If this…
Do this…
You forgot your password
On the Log In page, type your user ID into the User ID
field, and then click I forgot my password.
You need to contact your
PAA
Click Who controls my access? at the top of any page to
open a page containing PAA contact information.
You can’t see a pop-up
window
Set Internet Explorer to allow pop-ups related to Availity.
You can’t see the full
screen
Adjust the screen resolution of your monitor. Availity is
best viewed at higher resolutions.
You don’t want to type
data for each transaction
Start with an Eligibility and Benefits Inquiry and let the
data persist to the next inquiry or submission.
Ask your PAA to set up Maintain Provider for Express Entry.
You need help using
Availity
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Use Availity Help, including field-level help.
Contact Client Services at 1.800.AVAILITY (282.4548).
Have your transaction ID and organization ID ready.
©2011 Availity, LLC | All Rights Reserved
Thank you
Call 1.800.AVAILITY (282.4548)
Or visit us online at www.availity.com
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©2011 Availity, LLC | All Rights Reserved