As currently outlined in your provider manual, providers can submit claim payment reconsiderations verbally, in writing or electronically. We are reaching out to notify you about some exciting new tools for electronic submission that will become available through the Availity Portal. In addition, the Medicare Advantage provider manual has been updated with new information regarding claim remediation tools through the Availity Portal.

 

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

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

 

New Availity Portal functionality will include:

  • Acknowledgement of submission at the time of submission.
  • Notification when a reconsideration has been finalized by Empire BlueCross BlueShield.
  • A worklist of open submissions to check a reconsideration status.

 

With the new electronic functionality, when a claim payment reconsideration is submitted through 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 claim payment reconsideration will receive notification through Availity informing the user the reconsideration review has been completed. If you are not satisfied with the reconsideration outcome, continue to follow the process to file a claim payment appeal, as outlined in your provider manual.

 

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:

  • Log in to Availity at http://www.availity.com.
  • Select Help & Training | Get Trained.
  • Enter Appeals in the search field.
  • Enroll in a course.

 

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

 

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Featured In:
July 2019 Empire Provider News