Frequently Asked Questions Availity What is th
he Availity W
Web Portal? Availity offfers a multi‐p
payer portal aat availity.com
m that gives p
physicians, ho
ospitals and other heaalth care provviders access tto multiple paayer informattion with a seecure single sign‐on. Why is Em
mpire teamin
ng with Availitty? Availity offfers a varietyy of additionaal online soluttions to help reduce admin
nistrative cossts by eliminating paperworrk and phone calls. Our relationship witth Availity will help stream
mline transactions and processess. This will help reduce thee amount of p
paperwork forr medical practices allowin
ng you to spend more timee with your p
patients. What are the technicaal requiremen
nts to access Availity? All you neeed to access Availity is: • A com
mputer with in
nternet accesss. High speed
d is recommeended for best results. • Micro
osoft Internett Explorer 8.0 or greater (supports 128‐‐bit encryption). • A 102
24 x 768 or greater pixel display for bestt screen visib
bility. Is Availityy HIPAA comp
pliant? Yes. Availity is HIPAA ccompliant. How doess Availity pro
otect the privaacy and security of health
h information
n? Informatio
on is protecte
ed by registraation and can only be acceessed by desiggnated Availitty users. Availity does not sstore health iinformation, it only exchan
nges the information in strict compliance with privacy laws and regulations as necessary to complete the range of transactions p
performed by participants.. Is there a charge to usse Availity? No. The sttandard Empire health plaan transactions, including eligibility and
d benefits inq
quiry, claim sttatus inquiry an
nd any Empire
e‐specific functionality, i.ee. secure messsaging, are avvailable at no
o charge to heealth care providers. There aare no set‐up fees, monthly fees or perr‐claim fees ch
harged to pro
oviders for these transactio
on types. eady registere
ed for Empire
e’s Profession
nal or Facilityy provider portal, do I also
o need to register If I’m alre
for Availitty? Yes. The A
Availity Web P
Portal requirees you to regiister and obtaain a user ID aand password
d. It is not necessaryy for you to first register w
with Empire’s professional or facility porrtal for accesss to the Availity Web Portal. So what d
does this meaan for Empire
e’s Profession
nal or Facilityy provider portal? Is the to
ool going awaay? Effective 3
3/14/2014, access to eligib
bility, benefitts and claim status inquiry will be availaable only at www.availity.com. Avvaility is your new source tto access this valuable info
ormation. To avoid any disruption
n to accessingg information
n electronicallly, you will neeed to be fullyy transitioned
d to Availity W
Web Updated 0114 Services pro
ovided by Empire HealthChoice HMO
O, Inc. and/or Em
mpire HealthChoicee Assurance, Inc., licensees of the B
Blue Cross and Bluee Shield Association, aan association of in
ndependent Blue C
Cross and Blue Shield Plans. Page 1of 5 Portal as the services listed will no longer be available on Professional or Facility provider portal. Please ensure that every individual has their own individual User ID and password for Availity. Please register today and begin to access this information using Availity. Getting started with Availity Web Portal is easy and free training is available! Go to www.availity.com to register. What services are available through the Availity Web Portal? The Availity Web Portal offers the following transactions for providers treating Empire members in New York and BlueCard® members from out‐of‐state plans: • Eligibility and benefits inquiry • Claim status inquiry • Claim submission • Secure messaging ‐ If you need additional information or clarification on the status of a claim, you can send a secure email message that is routed electronically to the appropriate Empire provider inquiry area for response • Care reminders – clinical alerts on patients’ care gaps and medication compliance indicators • Patient care summaries ‐ real‐time, consolidated view of a member’s medical history across multiple providers • AIM Specialty HealthSM – link to precertification requests and inquiries through AIM Specialty HealthSM • Direct access to your legacy portal – Link to all your existing functionality, i.e. fee schedules, online remittances etc. using the link located under My Payer Portal in the left navigation bar. What are the advantages of using Availity? • No charge – Health plan transactions are available at no charge to providers. • Accessibility – Availity functions are available 24 hours a day from any computer with Internet access. • Standard responses – Availity returns responses from multiple payers in the same format and screen layout. • Send a question – Via a secure email, about a claim – this functionality is only available on Availity. • Commercial and government payers – Access to data from Empire, Medicare, Medicaid, and other commercial insurers. A full list of participating payers for each state by participation type is available at availity.com. • Compliance – Availity is compliant with the Health Insurance Portability and Accountability Act (HIPAA) regulations. Availity’s statement of compliance is available at availity.com. • Training – Free, live or on‐demand web‐based training seminars (webinars) are available. Providers simply log into the Availity portal and register to attend the webinars of their choice. Demonstrations, frequently asked questions, and comprehensive help topics are available online as well. Care reminders What are care reminders? Care remindersCare reminders are available on the Availity Web Portalfor Empire. It allows care reminderscare reminders to be displayed when running an eligibility and benefits inquiry for a patient. Page 2of 5 These messages direct your attention to targeted, personalized patient information with the intent to promote patient healthcare compliance and create greater awareness regarding disease symptoms, and health risks. Care reminders can also be accessed through patient care summary.. What type of information is in a care reminder? Messages contain a variety of important information on the member’s health, such as: • Patient health care compliance. • Patient‐triggered information and wellness tips. • Patient‐specific information on medications the patient has been prescribed. Why are care reminders important? • Care reminders help you better treat patients by improving quality and compliance making information about a specific patient available to you at the point of care. • These care reminders strengthen the patient/provider relationship by providing information which may not otherwise be readily accessible to you. What is the Feedback Form on the care reminder? Care reminders allow for your feedback by updating and/or correct a patient’s record. On the last page of the care reminder is a document for you to complete and fax to the number provided on the form. The feedback form is the same form that is currently sent to providers and has “Patient Highlights” at the top. Please Note: the ID number showing on the form is the patient’s internal MyHealth Advantage number, not the true HCID. How do I access care reminders? You can view care reminders either through an eligibility and benefits transaction or through a patient care summary. Will I see care reminders for all Empire patients? No. Care reminders are available for over 12 million members including all of Empire fully insured, Medicare Advantage, 500+ ASO within National and Local accounts who have purchased this enhancement, and FEP. In addition, these members are a part of MyHealth Advantage, a program that communicates issues like poor medication adherence and overdue tests and then sends the member a personalized and confidential message through the mail called a MyHealth Note. Does all Medical Information appear for a patient? No. Sensitive messages are suppressed. Sensitive messages consist of information related to certain medical conditions, such as mental illness, substance abuse, HIV/AIDS, sexually transmitted diseases, or abortion. This sensitive data is available via patient care summaries Who should I contact with questions about clinical information? Fax the feedback form to the number displayed on the form. However, if you wish to call, you can utilize the MyHealth Advantage call center at 866‐408‐7197. Is a member able to opt‐out of care reminders? Members can opt‐out of receiving MyHealth Notes mailings. When opting out, unless they expressly say “and don’t send anything to my doctor either” we do not cease messaging to the provider when a Page 3of 5 member opts‐out. However, if a member specifies that no messages are to be sent to their doctor, this information will not be displayed. How often will the same message appear? The message will reappear, if still pertinent, following the next data analysis. This analysis is typically performed at 30 day intervals. Patient Care Summaries What are patient care summaries? Patient care summaries areclaims‐based electronic medical records thatprovide up to 24 months of a patient’s most recent medical history from Empire across all health providers. It is a consolidated view of a patient’s care across providers, including diagnoses and procedures, hospital and physician visits, radiology history, immunizations, medication history, lab orders and results. Integration with care reminders provides a medical history combined with clinical insights. Why should I use patient care summaries? These summaries give you more information about a patient at the point of care. Advantages include: • Improving the speed of patient history intake, reducing clinician time and improving productivity. • Allowing you to determine, at the point of care, what health care services other providers have rendered. • Minimizing the need to rely on patients to remember medical and medication history, including prescriptions and dosages. • Better informed exams and decision making. How do I accessthis feature? A user must be assigned access by their PAA. Then, patient care summaries will be available from the eligibility and benefits inquiry screen or by submitting an inquiry from the side navigation menu. Are all medical records included in the summaries; even sensitive information? Yes. The screen will display the message: “May include sensitive information, does the user want to proceed?” When you opt to proceed, all data is presented. A record is kept of this response and your user information. If you opt not to proceed, data will not be presented. Is this information secure and compliant? Yes. These electronic medical records are fully secure and compliant with regulatory requirements. Patient care summary adheres to Continuity of Care Record (CCR) and Continuity of Care Document (CCD) standards. Is there reporting available for this feature? Yes. Patient care summariesprovide an Access Audit Report so the PAA knows who is accessing this functionality and for what patient. Who should I call if I have questions about the Availity Web Portal? You may contact Availity Client Services toll free at 800‐Availity (282‐4548) or e‐mail questions to [email protected]. Availity Client Services is available Monday through Friday, 8:00 a.m. to 7:00 p.m. (ET) (excludes holidays). Page 4of 5 Assistance for Providers already registered for Availity: • Availity Help – Once logged in to the Availity portal, click Help at the top of any page. Availity Help provides page‐level and field‐level context‐sensitive help. To find a specific topic, browse the table of contents in the left frame, or use the search box at the top, of the help window. To access help on a specific field, click the blue question mark next to the field name on the Availity portal page. • FreeTraining – Once you log in to the secure portal, you'll have access to many resources to help jumpstart your learning, including on‐demand training, frequently asked questions, and comprehensive help topics. To view the current training resources, click Free Training at the top of any page in the Availity portal. What is the difference between EDI, the Availity Web Portal and Physician/Facility Online Services (eBusiness portal)? Electronic Data Interchange (EDI) allows you to submit claims, retrieve remittance advices and retrieve claim file acknowledgements from your computer system via modem and phone lines directly to and from the insurance carrier or clearinghouse. Availity offers both a multi‐payer portal and an EDI clearinghouse. The multi‐payer portal that Empire is recommending optimizes the flow of information between health care stakeholders (including providers, health plans, pharmacies and others) through a secure internet‐based exchange. If you are currently submitting paper claims, Empire encourages you to utilize Availity’s single‐claim web portal claims submission opportunity. In addition, Empire encourages you to continue submitting claims through your current vendor or clearinghouse. Physician/Facility Online Services (eBusiness portal) is a secure site that gives you a wide range of online tools and resources to perform daily tasks. Physician/Facility Online Services are the eBusiness portals available in New York. The portals offers the convenience of accessing online services to confirm coverage and check claims, submit requests and inquiries for pre‐authorizations, obtain copies of remittances, view claim edit rules on Clear Claim ConnectionTM, download commonly used forms and reference materials, i.e. Sourcebook, and view policy and procedure information. Is Availity going to replace MD On‐Line? No. MD Online will remain available for Empire providers. Availity, an independent company, provides claims management service for Empire BlueCross BlueShield. Page 5of 5