CommercialMedicare AdvantageOctober 31, 2023
Reminder: Start using PDM capability now available on Availity Essentials prior to retirement of previous intake channels
This communication applies to the Commercial and Medicare Advantage programs from Anthem Blue Cross and Blue Shield (Anthem) in Colorado.
As we communicated in October, Availity Essentials Provider Data Management (PDM) is now available as the intake application for care providers to submit demographic change requests, including submitting roster uploads. As of January 1, 2024, Availity Essentials PDM will replace all current intake channels for demographic change requests and roster submissions. Providers should continue to utilize the Provider Enrollment application in Availity Essentials to submit requests to add new practitioners under existing groups. Read the previously published articles here:
Take action now
Don’t wait until January to start using the Availity Essentials PDM application. Start using it today to take advantage of the benefits of these options and familiarize yourself with the process before the legacy intake channels retire.
Benefits to our care providers using Availity Essentials PDM
The Availity Essentials PDM application will ensure the following:
- Attest and manage current provider demographic information
- 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 select the option that works best for you
Request data updates via either one of the following options within Availity Essentials PDM:
- Multi-payer platform option: allows providers to make updates once and have that information sent to all participating health plans, submitting each change separately
- Roster upload option: allows providers to submit multiple updates within one spreadsheet via the Upload Rosters feature:
- The Upload Roster feature is currently only available, and shared with, Anthem.
Want to submit a roster using Availity Essentials PDM?
Now you can. Roster Automation is our 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:*
- Utilize the Roster Automation Standard Template:
- For your convenience, there is a standard roster Excel document. Find it online at https://tinyurl.com/nerfdkkr.
- Follow the Roster Automation Rules of Engagement: Find it online at https://tinyurl.com/mw57cc49:
- This reference document is available to ensure error-free submissions, driving accurate and more timely updates through automation.
- 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).
- Upload your completed roster via the Availity Essentials 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 Essentials PDM. As of this date, all provider demographic change requests, including rosters, will be rejected if submitted through any format/channel other than Availity Essentials PDM. 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 Essentials 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 Provider Data Management by your Availity administrator. To find your Availity administrator, go to My Account Dashboard > My Account > Organization(s) > Administrator Information.
Training is available:
- Availity Essentials PDM application specific training:
- An Availity account is required for accessing these training options. If not registered yet, see end of this article for registration details:
- Roster Automation Template and Rules of Engagement specific training:
- Thursday, November 16, 4-5pm ET — Register November 16, 2023.
- Wednesday, November 29, 4-5pm ET — Register November 29, 2023.
- Wednesday, December 6, 4-5pm ET — Register December 6, 2023.
- Tuesday, December 12, 11-12pm ET — Register December 12, 2023.
- Monday, December 18, 4-5pm — Register December 18, 2023.
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 going to Availity.com and selecting New to Availity? Get Started at the top of the home screen to access the registration page.
If you have questions regarding registration, reach out to Availity Client Services at 800‑AVAILITY (800-282-4548).
Start using Availity Essentials 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.
- Any specific state mandates or requirements for provider demographic updates.
* If any roster data updates require credentialing, your submission will be routed appropriately for further action.
Carelon Behavioral Health, Inc. is an independent company providing utilization management services on behalf of the health plan.
COBCBS-CRCM-041492-23-CPN41168
PUBLICATIONS: November 2023 Provider Newsletter
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