PDM capability available on Symphony Provider Directory and Availity Essentials — retirement of previous intake channels January 1, 2024

As we continue our path to be your most valued partner in the industry, we’d like to share an update on how your organization should verify and initiate care provider demographic change requests for all professional and facility care providers.** Going forward, Availity Essentials* Provider Data Management (PDM) and Symphony* file-based data exchange are now the two options for care providers to submit demographic change requests, including submitting roster uploads. Availity PDM and Symphony will replace all current intake channels for demographic change requests and roster submissions as of January 1, 2024. 

While there are two options available, providers only need to use one. The Availity PDM option is available at no cost to providers, and the Symphony option is a premium service available for an additional cost if providers choose to sign up for it. If preferred, providers may continue to utilize the Provider Enrollment application in Availity Essentials to submit requests to add new practitioners under existing groups.

Option 1: Availity PDM application via Availity Essentials (available at no cost to care providers)

The Availity PDM application allows you to:

• Update provider demographic information for all assigned payers in one location.
• Attest and manage current provider demographic information.
• Review the history of previously verified data.

Option 2: Symphony file-based data exchange (premium service available to care providers for a fee)

As we communicated in February, Anthem is participating with Symphony, California’s centralized platform for provider directory data, led by the nonprofit organization, Integrated Healthcare Association. Providers can choose to work directly with Symphony for file-based data exchange and for multi-plan data submission, attestation, and reporting. Symphony benefits medical groups by reducing administrative burden, improving data quality, and supporting compliance. Contact the Symphony team here if you are interested in learning more.

Benefits to our care providers using Availity PDM

The Availity PDM application will ensure the following:

• Consistently updated data
• Decreased turnaround time for updates
• Compliance with federal and/or state mandates
• Improved data quality through standardization
• Increased provider directory accuracy
• Choice and flexibility to request data updates via the standard Availity PDM experience or by submitting a spreadsheet via a roster upload

Benefits to our care providers using Symphony:  

• Submit and attest to data for many health plans at one time with 17 health plans currently participating.
• Improve data quality through standardization and reports that highlight data discrepancies.
• Comply with federal and/or state mandates as well as with health plan requirements.
• Partner with Symphony Client Success team members who advocate for each Symphony participant’s unique needs.

Want to submit a roster using Availity PDM?

Now you can. Roster Automation is the new technology solution designed to streamline and automate provider data additions, changes, and terminations that are submitted using a standardized Microsoft Excel submission. Any provider, whether an individual provider/practitioner, group, or facility, can use Roster Automation today:***

1. Utilize the Roster Automation Standard Template:
   • For your convenience, there is a standard roster Excel document. Find it online here.
2. Follow the Roster Automation Rules of Engagement:
   • This reference document is available to ensure error-free submissions, driving accurate and more timely updates through automation. Find it online here.
   • More detailed instructions on formatting and submission requirements can also be found on the first tab of the Roster Automation Standard Template (User Reference Guide).
3. Upload your completed roster via the Availity PDM application.

What about the previous methods by which I have been submitting information?

While we are in the process of sunsetting our legacy intake channels, we will continue to process submissions received through current intake channels until December 31, 2023. Effective January 1, 2024, all PDM requests, including rosters, must be submitted via Availity PDM or Symphony. As of this date, all provider demographic change requests, including rosters, will be rejected if submitted through any format/channel other than Availity PDM or Symphony. Again, if preferred, providers may continue to utilize the Provider Enrollment application in Availity Essentials to submit requests to add new practitioners under existing groups.

How to access the Availity PDM application

Log onto Availity.com and select My Providers > Provider Data Management to begin the attestation process. If submitting a roster, find the TIN/business name for which you want to verify and update information. Before you select the TIN/business name, select the three-bar menu option on the right side of the window, and select Upload Rosters (see screen shot below) and follow the prompts.  

Availity administrators will automatically be granted access to PDM. Additional staff may be given access to PDM by an administrator. To find your administrator, go to My Account Dashboard > My Account > Organization(s) > Administrator Information.

Training is available:

• Availity PDM application specific training: (Availity account is required for accessing these training options. If not registered yet, see end of article for registration details.)
  • Learn about and attend one of our live webinars by visiting here. (Note: You must log into Availity first. Then, select the link.)
  • View the Availity PDM quick start guide here. (Note: You must log into Availity first. Then, select the link.)

Not registered for Availity yet?

If you aren’t registered to use Availity Essentials, signing up is easy and 100% secure. There is no cost for your providers to register or to use any of our digital applications. Start by logging into Availity.com and selecting the Register icon at the top of the home screen, or you can use this link to access the registration page. 

If you have questions regarding registration, reach out to Availity Client Services at 800-AVAILITY.

Start using Availity PDM today to improve your provider data management experience.

** Exclusions:

• Behavioral Health providers assigned to Carelon Behavioral Health, Inc.* will continue to follow the process for demographic requests and/or roster submissions, as outlined by Carelon Behavioral Health.

*** If any roster data updates require credentialing, your submission will be routed appropriately for further action.