Electronic claim payment reconsideration

Currently, providers can submit claim payment reconsideration requests verbally, in writing or electronically. We are reaching out to notify you about some exciting, new tools for electronic submission of Medicaid claims that will become available through the Availity Portal. You should soon see changes in your provider manual that will outline this new information.

 

Beginning June 17, 2019, providers will have the ability to submit claim reconsideration requests through the Availity Portal with more robust functionality. This means an enhanced experience when:

• Filing a claim payment reconsideration request.
• Sending supporting documentation.
• Checking the status of a claim payment reconsideration.
• Viewing your claim payment reconsideration history.

 

New Availity Portal functionality will include:

• Immediate acknowledgement of submission.
• Notification when a reconsideration has been finalized by Anthem Blue Cross and Blue Shield.
• A worklist of open submissions to check a reconsideration status.

 

With the new electronic functionality, when a claim payment reconsideration request is submitted via the Availity Portal, we will investigate the request and communicate an outcome through the Availity Portal. Once an outcome has been determined, the Availity Portal user who submitted the claims payment reconsideration request will receive notification informing them that the reconsideration review has been completed. If the user is not satisfied with the reconsideration outcome, they should continue to follow the existing process to file a claim payment appeal as outlined in the provider manual.

 

To register for a webinar or access a recorded webinar:

1. Log in to the Availity Portal at https://www.availity.com > Select Help & Training > Select Get Trained.
2. From the Availity Learning Center, enroll using one of the following methods:
1. Select the Dashboard drop-down arrow > Select Catalog > Select Sessions > Select the date of the webinar > Select the webinar title > Select Enroll.
2. While in the Catalog, select the Search button > Enter the webinar title > Select Enroll.

 

Providers who have questions as they begin to use the new functionality should contact Availity at 1‑800-282-4548.