Update: New process to submit claim payment disputes electronically coming March 18, 2019

We wanted to give you an update to an article previously communicated in our January 2019 Provider Newsletter regarding the launch of the claim payment dispute tool on the Availity Portal.  We had targeted this new tool to be available in early March, and we are now targeting March 18, 2019.  When this tool launches it will be available for Local Plan member claim payement disputes.  We are anticipating the tool will be available for BlueCard member claim payment disputes shortly after this launch.  We will send another announcement when claim payment disputes become available for BlueCard members.  (Please note:  Federal Employee Program (FEP) member claim payment disputes are out of scope for this tool at this time.)

 

At the time of our launch of this new tool, you will have the ability to submit claim payment disputes electronically through the Availity Portal using the new Dispute Claim option accessed from the Claim Status page.

 

This tool makes it easier to:

• Electronically file a claim payment dispute
• Send supporting documentation
• Check the status of your claim payment dispute
• View your claim payment dispute history

 

A Claim Payment Reconsideration will be the first step of a claim payment dispute submitted through Availity.  Anthem will review the request and communicate an outcome through the Availity Portal back to you. If needed, you can then choose to submit a Claim Payment Appeal.

 

Once the claim payment dispute is submitted for a second time (through the Claim Payment Appeal step), the decision is final, and may not be submitted again.

 

All Users with the Role assignment of “Claim Status” will have access to the Dispute Claim option from the Claim Status page.  Contact your Availity Administrator to obtain access, if you do not currently have “Claim Status” functionality.

 

Claim Payment Dispute Tool Training

 

You can get a jump start on your training and be ready to go as soon as the tool is fully launched.  To learn more about the claim payment dispute tool, register for a live webinar or view a previous recording:

1. Log in to Availity at www.availity.com and select Help & Training | Get Trained
2. Type Appeals in the search field
3. Enroll in a course

 

Claim Status and Remittance Inquiry page enhancements

 

When the claim payment dispute tool is launched, you will notice some other changes to the Availity Portal Claim Status and Remittance Inquiry page:

 

• You will see a new option under the Claims & Payments menu for “Claim Status and Remittance Inquiry”. Once this tool is launched this new link will replace the previous “Claim Status Inquiry” link (see screen shot below).  
  • Note: If you previously had “Claim Status Inquiry” saved as a favorite, you will need to save the new “Claims Status and Remittance Inquiry” link as a favoriate as the favorite feature will not transfer over to the new link automatically. 

• You will also see a new Go To menu on the patient Eligibility and Benefit Detail page to navigate seamlessly to the new Claims Status and Remittance Inquiry page.

• The new claim status look also includes color coded patient ID cards and easy to read claim detail.

 

Secure Messaging Changes

 

Once the claim payment dispute tool is launched, you will also see changes to the Secure Messaging tool.  A new Actions menu on the updated Claim Status page will be used to access the Secure Messaging tool. The link Do you have a question about this claim? will no longer be available with the update to this page.  You can also use the Actions menu to edit or print the claim screen.

 

Claim Status Tool Training

 

To learn more about the changes to the claim status tool, view the training demo:

1. Log in to Availity and select Help & Training | Get Trained
2. Type Claims Status – Training Demo in the search field
3. Enroll in the course

 

“Working with Anthem” webinars

 

Don’t foget we are also hosting our “Working with Anthem” webinars this month and the topic will be the new Claim Payment Dispute tool, as well as, the additional changes to Claim Status page and the Secure Messaging tool.  A representative from Availity will be a guest presenter and providing a live demo.  Check our our registration link to register today!