Receive and respond to post pay audit medical record requests via Availity beginning February 10, 2020
We are launching the use of Availity’s medical attachment functionality to begin requesting medical records and itemized bill information from providers electronically instead of paper requests. This change applies only to the process of requesting and receiving medical records; it is not a change to the audit program. We began transitioning providers to this new process in an active limited launch in October 2019. We will complete the transition by February 10, 2020.
Important facts regarding this change:
- This change only affects providers who use Availity and who have opted into using the medical attachment functionality through the permissions in Availity’s enrollment center.
- The new functionality is for medical record requests for post pay claims for the Payment Integrity Quality Claims Review (provider audit) department only.
- There will be no duplicate requests (both paper and electronic).
- In Availity, the request will come into the provider’s Medical Attachment “inbox”:
- The original letter historically sent via paper is accessible through a hyperlink in the Availity system as a pdf electronic copy. The letter content is the same as it was in paper format.
- Each electronic request letter will have a timeframe for responding to the request. After the timeframe has passed for that letter, you will not be able to respond to that electronic letter. If you wish to upload medical records after the response time has expired, please refer to the Availity training referenced below.
- Providers can respond to the request by uploading records in Availity. The attachments are received in almost real time and are delivered electronically to the payer’s systems through secure means - - nothing is stored in Availity.
- The following are not included or not impacted:
- Vendor requests for medical records on behalf of the payer.
- Providers that do not use Availity or have not turned on permissions for Medical Attachments within Availity.
- The request timing or verbiage in the request letter.
- At this time, the Program Integrity Special Investigations Unit (SIU) post pay review, but they will be included at a future date.
Training is available in Availity located here Availity Training on Electronic Medical Records for Program Integrity.
Can I start using the functionality earlier?
Yes. If you chose to opt in earlier, please ensure you are configured within Availity. You may request early access via this email address: dl-Prod-Availity-Provider-Support@anthem.com.
For additional information, see the attached Frequently Asked Questions.
January 2020 Anthem Maine Provider News