How to add a payer to payer spaces on availity

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I see multiple out-of-state Premera patients for physical therapy services. The best practice is to choose the local Blue plan you're contracted with or "Other Blue Plans" if it's listed in the payer drop down.

After entering the patient's information, the system will route you appropriately. If the local Blue you're contracted with for Other Blue Plans isn't listed in the payer drop-down menu, you can add a state by contacting Availity Client Services at , 8 am-8 pm ET Mon-Fri. How do we get access to other payers on our account?

Payers are automatically added as they roll out new applications in a region state. If a payer has rolled out an app in your region, but you don't see the payer's name in the payer drop-down menu for that region and app, you can contact Availity Client Services for assistance at , 8 a. ET, Monday — Friday. Can I initiate an inpatient prior authorization without uploading documentation? We need to be able to review the medical reason for the request.

What about providers who have auto authorization with Premera for specific services? How does that work? Clinical criteria is built into the prior authorization workflow that recognizes a provider's TIN approved for auto authorization services.

The requester goes through the process flow and won't need to submit any attachments for the request. Once the request is completed, the request is auto approved.

If there are multiple doctors performing a surgery, can you add a co-surgeon to the prior authorization? The Availity prior authorization workflow includes the requesting provider, rendering provider or provider providing the service and facility if applicable. If the member becomes active as of May 1, for example, but the provider is trying to submit the authorization in April, are they able to submit the request online?

When a provider enters a prior authorization request, an eligibility and benefits check appears. If the member isn't loaded in our system as an active member, it will return a message that the member isn't eligible. After a provider sets up an authorization and they want to send additional clinicals, can they come back and attach them after the authorization is submitted? The provider will need to fax any additional documents to Premera. Please include the request's certification reference number on your fax.

Will the tool show you or stop you if the prior authorization request has already been submitted, so that you don't duplicate the request? Is there a prior authorization form to fill out?

No, the Availity prior authorization tool is an online workflow that walks the requester through the process step-by-step. The steps could be different depending on the type of services requested.

The "rendering provider" is the provider requesting the prior authorization vs. Is that correct? Can you edit the servicing provider after it's submitted? No, once a request is submitted, no additional changes can be made to the request.

Is this limited to prior authorizations or can requests for additional services be completed through Availity? This is limited to prior authorizations only. Can a specialist submit a prior authorization or only the primary care doctor?

Can prior authorizations be retro? Authorizations for procedures can be submitted by either a specialist or a PCP. They should not be retro as they need to be approved before the service is performed. Can prior authorization requests be requested for inpatient, outpatient, and specialty office visits?

Office visits would be a referral. Admissions and services are subject to prior authorization. How can I use the Availity authorization dashboard? Can we filter by CPT code?

Are the uploads. PDF only? Availity accepts several different file types. The different types of files are noted on the attachments page. Files must be in doc, docx, gif, htm, jpg, pdf, png, ppt, pptx, tif, txt, xls or xlsx format, no more than 10 files may be added. Is there an easy way to pin the transaction IDs to my Availity dashboard? Availity Client Services can use other information to locate the prior authorization request if you call for assistance and don't have the transaction ID for the request.

We're an ambulance company that provides air and ground services. We send our records through email and mail to Premera and Premera BlueCard. Are we able to send these records through Availity? If Premera isn't listed, do we need to contact the client services?

What does the red triangle with the exclamation in the dashboard mean? This is a message from the payer. If you hover over it, you'll see specific details. What if both provider sections are the same provider? Currently, you'll need to enter the provider's NPI again. We'll work on a future enhancement, so you only need to enter it one time. Will we be able to authorize medications through Availity or is that only for procedures?

Medical drugs such as infusions can be requested in Availity. View all pharmacy drugs requiring approval and how to request approval. What is Premera's timeframe to complete a prior authorization? Authorization requests are submitted to Premera in real-time. We typically respond to requests within 5 days, but it may take up to 15 days if we need additional information.

Do you have to have the provider on your account to follow up on prior authorization requests? You can manually enter provider information, so adding them to your account via the Add Providers process on the Manage My Organization page is optional.

However, adding them helps you choose them from the Select a Provider drop down which will auto-fill their information. Do you ever get an automatic approval or do they all pend for review? Yes, some requests are auto-approved. 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. The drop down under the Patient Search Option field will show these choices. If this happens, utilize another search option field to enter more data, such as the Patient ID. Provider Manual. Medicaid Expansion Provider Manual.

For detailed instructions, see Availity Essentials help topics for Authorizations and Referrals requires login to Availity Essentials. Additional information regarding referrals can be found here or within the appropriate provider manual. Availity Essentials does not have the functionality to determine if a code requires precertification or not. Note: Medicaid Expansion has its own precertification search function under the Medicaid Expansion tab of the www. More information regarding authorization requirements can be found in the applicable provider manual:.

You do not need to submit a request in this case. Watch the Availity Essentials Messaging a Payer training video or view the Messaging help topics for specifics on how to access and use this feature requires login to Availity Essentials. Once the appeal is received, you can verify appeal status as noted above. Do not re-open a message after 30 days. If you have an additional question regarding the same claim, please submit a new direct message request.

Can you please provide more information regarding this denial? For detailed instructions, see Availity Essentials help topics for Transaction Enrollment requires login to Availity Essentials. Once enrolled the access to the administrator should be granted immediately.

The administrator can then grant access to other users within their facility accordingly. For detailed instructions, see Availity Essentials help topics for Remittance Viewer requires login to Availity Essentials. If a provider is signed up for Availity Essentials, the ERA tool can be utilized, even if the claim was not submitted through Availity Essentials. For more information and instructions, see Directory Validation Instructions. Information regarding ERA can be found above.

You can check your EFT submission progress status at any time by accessing the Transaction Enrollment page. Reimbursement for claims submitted after the EFT effective date will send payment electronically. Learn more information on how to register by reviewing the Availity Essentials getting started course. To begin registration on Availity Essentials click here. Note: Access is granted shortly after registering.

However, if the information submitted does not complete a match, it will be manually reviewed, which can take up to 60 days. For technical issues or questions regarding how to use Availity Essentials contact Availity Essentials Client Services. Phone Number: Monday through Friday, 7 a. Once registered with Availity Essentials you can take advantage of on-demand, free training courses and resources to learn about administrator responsibilities, how to submit a claim, sign up for payment remittance advice notification and more!

Log in to your Availity Essentials account to access training videos and resource materials through:. Fargo Headquarters 13th Ave. Fargo, N. All rights reserved. High call volume Our customer contact center is currently experiencing high call volumes.

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