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 in an active limited launch to this new process 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 exactly 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.

Resources

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 our Frequently Asked Questions below:

 

How will I know I have access to this new functionality?

If you are a user with this privilege, you will receive an initial notification through the Availity Notifications center letting you know when the functionality is available. There will also be  a link to the training in that notification.

 

Once I activate the new Medical Attachment functionality, what will happen?

Once you activate the functionality, it will notify the payer and from that date forward, the letters will come through electronically and will no longer be sent via paper.

 

What happens if I use Availity and am using this functionality, and then remove the privilege in Availity?

Once you deactivate the functionality, it will notify the payer and from that date forward, the letters switch from Availity back to paper copy.

 

If we have feedback for you, who should we contact?

Provide feedback to this email address dl-Prod-Availity-Provider-Support@anthem.com.

 

Can we still submit via paper?

Yes, you may still follow the instructions in the letter to submit medical records using the other means available.

 

After the records are submitted, can I still see what was sent?

Yes, you will have an electronic record of the submission in the “history” tab.

 

Will I be notified when a request comes in? 

Yes, Availity will send you an email and add a notification in the notifications area to be alerted that there is a new request in the inbox.

 

What about the timelines?

The request will be in alignment with the current timelines for the letter.  If the letter indicates you have 30 days to upload the records, within Availity the request will show the countdown of the days until the request will expire.  Once it expires, the request will move to the History tab.  If you did not respond to the first notice, it will expire, and a second notice with the next due date will appear, until the final notice appears and then expires.  If all notices have expired, you may still upload the medical attachments using Availity through the Send Attachments option in the Attachments application.

 

This is for Availity. What about other provider portals?

We continue to look for system enhancements to improve the provider experience.  We will advise you as enhancements are rolled out.

 

Is there a file size upload limitation?

The current upload is 100MB in cumulative.  For example, you can upload two files that are each 50MB, or one file that is 100MB. 

 

What do I do if the files are larger than 100MB?

Feel free to reach out to the Provider Call Center to communicate this is an issue for you. Continue to submit the medical records that you can through the portal, and for additional medical records, use the Send Attachment option in the attachments application in Availity.  You may continue to send records in the other means listed in the letter.