Embed Size (px)
Citation preview
Availity, L.L.C. All Rights Reserved. Confidential and Proprietary. �
Focused on making your job easier, faster, and more productive ... August2007
Upcoming WebinarsLive webinars last one hour. To register, click Free Training on any Availity page and follow the instructions.
Message Center - 8/1 at 10:30 am MT, 11:30 am CT, 12:30 pm ETEDI Submitters - 8/2 at 10:30 am MT, 11:30 am CT, 12:30 pm ETWeb Claims Submission & Inquiry - 8/7 at 10:00 am MT, 11:00 am CT, 12:00 pm ETMaintain Provider & Express Entry - 8/8 at 10:30 am MT, 11:30 am CT, 12:30 pm ETAuthorizations & Referrals - 8/9 at 10:30 am MT, 11:30 am CT, 12:30 pm ETCare Profile (Florida only) - 8/16 at 10:00 am MT, 11:00 am CT, 12:00 pm ETEligibility & Benefits - 8/21 at 10:00 am MT, 11:00 am CT, 12:00 pm ETPAA Training - 8/22 at 10:30 am MT, 11:30 am CT, 12:30 pm ETEDI Training for Former THIN Submitters - 8/23 at 11:00 am MT, 12:00 pm CT, 1:00 pm ET
•
•
•
•
•
•
•
•
•
Keying Forms – Tips for Easier, Faster Data Entry
Did you know that you can complete most Availity forms using
the keyboard almost exclu-sively? That’s right! Instead of using the mouse to select buttons, check boxes, and items from menus, you can use the keyboard. Becoming accustomed to using the key-board instead of the mouse can reduce switching between them and make data-entry more smooth and speedy.
Try these tips in a form:
Press the Tab key to jump from one field to the next. For dates, the application usually tabs automati-cally between the month, day, and year fields.
To move the cursor to a previous field, press Shift-Tab.
When a menu is “highlighted” like this …
•
•
•
If more than one item in the menu starts with that letter, type the letter repeatedly until the correct item displays.
When you move the cursor from a field to a radio button (a circle that you click), a dotted-line box appears around the button like this …
•
… the menu is “in focus.” Type the first letter of an item in the menu to make the item display.
For example, when the Payer field is in focus, you can type an “H” to select Humana.
… meaning the radio button is “in focus.” Press the spacebar to select it, or press the arrow key to move to the next radio button and select it.
When a button changes from this …•
… to this …
Note: Some forms may have fields that don’t allow you to “tab” to them. Availity is working on improving the keyboard-friendliness of its forms in an upcoming release.
… it is “in focus” and you can press Enter to “click” the button.
� Availity, L.L.C. All Rights Reserved. Confidential and Proprietary.
August2007 Availity e-Focus
Availity e-FocusWant this newsletter by e-mail? Send a message to: [email protected]
For newsletter suggestions: [email protected]
For customer support: [email protected]
Availity, L.L.C.P.O. Box 550857
Jacksonville, FL 32255-08571.800.AVAILITY (282.4548)
Delayed EDI responses are gener-ated by payers that process files
in batches or use other non-real-time adjudication processes. Payers may send delayed responses for claims after Availity has sent the electronic batch report (EBR) to the provider.
Once Availity receives a delayed response from a payer, it delivers the response as a Delayed Payer Response (DPR) file to the provider’s ReceiveFiles mail box in Availity.
DPRs may include transaction receipt acknowledgements, rejection messages, and warning messages, as well as any adjudication responses returned by the payer.
Availity generates a DPR for each delayed payer responses received each day. If Availity receives no delayed payer responses for the provider, no DPRs are generated that day. Furthermore, not all payers return delayed responses.
Often, a provider can receive many individual DPRs each day, one for each claim submitted, creating a management nightmare for the provider. To deal with all of these
files, the provider’s Primary Access Administrator (PAA) can choose to receive all individual DPRs for a 24-hour period in a single DPR file.
PAAs follow these steps:
Log into Availity. Then, in the Availity menu on the left side of the page, select EDI File Management | EDI Reporting Preferences.On the EDI Reporting Preferences page, locate the heading Claims Delayed Payer Report DPR.Select the check box next to Receive Delayed Payer Reports (DPR) linked to-gether in one data file and/or text report per day.Complete the accompanying time field.Click Submit.
Note: You must correct and resubmit any rejected claims. If necessary, please contact your vendor for techni-cal support or the payer for additional information about rejections.
See the Availity EDI Guidelines, chapter 6, “The Delayed Payer Report (DPR)” section, which con-tains a delimited file layout showing you how to parse this report. This document is located on the Availity Resources page. Log into Availity and click Availity Resources.
1.
2.
3.
4.
5.
Customer Service Corner
Receiving Multiple Delayed Payer Responses in a Single File Each Day
Where’s Availity?Availity will attend these events:
Florida College of Emergency Physicians - 8/2 - 8/5, Naples (http://www.fcep.org/)BlueNews Hospital Seminars (Florida Only - Contact your BCBSF Provider Relation Specialist, or PRS, to attend)
8/22 - Fort Lauderdale8/23 - Lake Buena Vista8/29 - Jacksonville
Florida Medical Assoc. Annual Conference - 8/23 - 8/26, Hollywood, FL (http://www.fmaonline.org/annu-alexpo/default.asp)BCBS Information Management Symposium - 9/9 - 9/12, Amerlia Island, FL (http://imsymposium.bcbsfl.com/index.cfm)Texas MGMA 2007 Legislative Update - 9/20 - 9/21, Austin, TX (http://www.tmgma.org/cde.cfm?event=158535)National Plan Automation Group (NPAG) Annual Conference - 9/23 - 9/26, Chicago (http://www.npag.org/)GE Centricity Healthcare Users Group (GE CHUG) Fall Conference - 9/28 - 9/29, Chicago (http://www.beatty-group.com/chug.htm)Harris County Medical Society Business Expo - 10/20, Houston, TX (http://www.hcms.org/template.aspx?id=248)MGMA Annual Conference - 10/28 - 10/31, Philadelphia (http://www.mgma.com/)
•
•
---
•
•
•
•
•
•
•
Availity, L.L.C. All Rights Reserved. Confidential and Proprietary. �
Availity e-Focus August2007
Florida News
More Options in CareCalc
Until now, CareCalc could be performed only for professional
services rendered in an office or ambulatory surgical center. On July 23, Availity and Blue Cross Blue Shield of Florida (BCBSF) intro-duced additional place of service options for the professional CareCalc transaction. Physicians who render services in an outpatient or inpatient setting will find these improvements especially useful.
Also, BCBSF now returns infor-mation on the type of product the member is covered under on the CareCalc results screen.
CareCalc is available to a growing number of professional providers. The February issue of Availity e-Focus featured an article about it. For more information, you can also click Help at the top of any Availity page and see the CareCalc topics.
Eligibility & Benefits Now Improved!
On July 23, Availity released some exciting changes to its
Eligibility and Benefits (E&B) Inquiry transaction. These changes will help improve provider office workflow, reduce the amount of paper wasted on printing unneeded results, and satisfy user requests to make patient searches easier.
The July issue of Availity e-Focus featured an article about these changes.
For more information about Availity’s Eligibility and Benefits Inquiry feature, click Help at the top of any Availity page.
Availity Library Revamped
The Availity Library is now replaced by two new resources
pages.
Availity ResourcesThe Availity Library has been replaced by an Availity Resources page. It contains links to My Availity Dashboard, My Products and Services, and My Code Lists, as well as the Availity e-Focus news-letter archive. To access it, click Availity Resources at the top of any Availity page.
Payer ResourcesPayer items previously located in the Availity Library are now accessible in the Payer Resources pages. Each payer’s information displays on its own page, making it easy to locate the information you need, such as provider directories and payer user manuals. To access these pages, click Payer Resources at the top of any Availity page.
CareCalc Institutional Coming Soon!An institutional version of CareCalc will be made available to hospitals for outpatient services later this year. Stay tuned to Availity e-Focus for more information!
BCBSF Detailed Facility Claims: New Facility Type
Availity has added a Home Health Outpatient facility
type to the Facility Type field in the Detailed Facility Claim form when the payer is Blue Cross Blue Shield of Florida (BCBSF).
When you select Home Health Outpatient, a new field, Frequency, also displays.
The Frequency field displays and is required only for Home Health Outpatient. Why? Because for other facility types, only one or two fre-quencies may apply, and Availity can automatically submit the appro-priate frequency for you. However, for Home Health Outpatient, any of four frequencies may apply. Because Availity can’t guess which frequency is the right one for the claim, you must select it.
The Frequency field includes these four values for Home Health Outpatient:
Admit through DischargeInterim First ClaimInterim Continuing ClaimInterim Last Claim
You can access the Detailed Facility Claim form by clicking Claims Management | Facility Claim in the Availity menu. For more infor-mation about facility claims, click Help at the top of any Availity page.
1.2.3.4.
� Availity, L.L.C. All Rights Reserved. Confidential and Proprietary.
August2007 Availity e-Focus
Availity e-Focus Crossword PuzzleClick the Print icon in the Adobe Reader toolbar to print the newsletter or just the crossword. Unless hints are noted, you can find answers scattered throughout this issue. The solution will be published in the next issue.
Across1. DPRs are ________ payer responses.4. An ____________ version of CareCalc will be
made available to Florida hospitals for outpatient services in the near future.
8. You can use this device almost exclusively when completing web forms in Availity, such as claims, eligibility and benefit inquiries, and others.
9. When a menu, button, check box, or something else on the screen is highlighted or has a dotted box around it, it is ____ __________, and you can use your 8 Across to select it. (2 words)
10. This field displays and is required when the payer is BCBSF and the facility type is 3 Down.
Down2. Availity items found previously in the Availity
Library are now located in this place. (2 words)3. This new facility type was added to the Detailed
Facility Claim form for BCBSF. (3 words)5. PAAs can choose to receive DPRs in a single DPR
file each day on the EDI Reporting __________ page.
6. Payer-related items found previously in the Availity Library are now located in this place. (2 words)
7. Availity and BCBSF introduced additional options for __________ to the professional CareCalc trans-action. (3 words)
Solution to July’s puzzle:1
2
3 4
5 6
7
8 9
10
11
12
13
14
T
C
C
H
A
F
L
U
I
R
S
E
A
R
C
H
O
P
T
I
O
N
R
E
E
P
I
T
P
E
R
S
I
S
T
E
N
C
E
B
T
Y
R
T
O
N
O
T
E
P
A
D
O
O
W
O
R
D
W
R
A
P
A
D
U
N
F
A
Y
R
G
W
E
B
I
N
A
R
S
I
D
U
L
N
S
E
A
D
J
U
D
I
C
A
T
I
O
N
T
N G
E
C
H
U
G
Created with EclipseCrossword - www.eclipsecrossword.com
1 2
3
4
5 6 7
8
9
10
Created with EclipseCrossword - www.eclipsecrossword.com
