Overview
Everything you need to work with your payers
You work with payers every day—and those interactions can be complicated. Availity Essentials makes it easier to connect with your payers, from the first check of a patient's eligibility through final resolution of your reimbursement.
Availity Essentials features an intuitive interface and supports multiple workflows, simplifying the exchange of administrative, clinical, and financial data with your payers.
Availity Essentials connects you with payers in a variety of ways
Online, direct data entry with intuitive workflows
Availity Essentials gives you free, real-time access to many payers through your browser. It’s ideal for direct data entry, from eligibility to authorizations to filing claims, and getting remittances. Many sponsoring payers support special services on the platform like checking claim status, resolving overpayments, and managing attachments.
Free access to hundreds of payers
From the first phone call with a new patient through final claim reconciliation and payment, you need a simpler way to collect, submit, and track the administrative, clinical, and financial data that make healthcare possible.
Availity Essentials is the place to connect with your payers—at no cost to providers. We work with hundreds of payers nationwide to give providers a one-stop-portal where they can check eligibility, submit claims, collect patient payments and track ERAs, and even sign up for EFT. Your Essentials account gets you access to all this and more, with one password.
You can also update your provider profiles, manage quality-of-care paperwork, and get detailed reporting about your office’s standard HIPAA and other payer transactions.
Standardized workflows make it easy for you to handle:
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Authorizations and Referrals
Auths cause more headaches in your office than almost any other step in working with your payers. Is an authorization needed? Are there separate forms for inpatient or outpatient procedures?
Easier, Faster, Smarter
Most of the payers you’ll find on Essentials offer real-time authorizations. Just start with the basic information, and we’ll pre-populate as many of the fields as we can, and in just a few minutes you’ll have an answer that’s straight from the payer.
We’re also working with several leading payers to simplify the process even more, with a question-and-answer format rather than the on-screen forms.
Our new dashboards let you quickly check the status of all the auths requested by your office. For selected payers, you can even provide unsolicited attachments that you know the payer will need for approval.
Once the visit is over, it's time to start the paperwork that gets you paid: claims.
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Claims
Submitting claims has never been easier—whether you want to key them in one at a time or submit batch claims through electronic data interchange (EDI). Use Essentials to submit professional, facility, or dental claims to hundreds of payers at no cost to you, and send claims to even more payers with an Essentials Plus subscription.
Once you’ve submitted a claim, you can see what’s happening with it through standard claim status inquiries.
Submitting single, multiple, or batch claims
Click once to get to the claims page from a patient card on the eligibility screen. Pick your payer and start your claim with as little as the patient’s name, date of birth, and insurance information.
We’ll do a quick check on your claim when you click “Submit,” just to make sure you’ve avoided the most-common errors that can cause your claims to pend or get denied.
If you’re looking for a more robust app to integrate directly with your Epic (or other) EHR, look into Essentials Pro, our revenue cycle management solution. You can get pre-service clearance tools, advanced denial prevention and management, and more.
Upload multiple claims
Does your PMS or EHR system let you export your claims in standard 835 format? You can upload that file through the Availity Essentials and submit your claims in a batch. Each claim is still individually tracked, so you can get up-to-date information on your claims any time you need to check their status.
Need an integrated solution, or want to automate your uploads? Check out Availity’s EDI solutions.
Check your claim's status
No more hopping from payer portal to payer site—and no more waiting on hold to find out if your claim has pended or been denied. Check the status of your claims for most of our sponsoring payers, and get real-time information about what you need to fix, add, or re-submit so you can collect what you’re owed.
Every payer has a unique way to find out about your claims. The Claim Status workflow in Essentials lets you pick your payer, then walks you through just the questions you need to answer to get the insights you need. Check on a specific claim for one encounter, or get a look at all your claims that payer is currently processing.
Remittances - Collect what you're owed
Because you checked your patient’s eligibility at the beginning of the encounter, you know how much of the cost of treatment they are responsible for. Availity integrates patient payments right into the Essentials workflows and include cost-efficient (and simple) payment processing by a trusted national payment processor. You can swipe a card or set up recurring payments to help spread the patient’s cost out over time.
Most payers can deliver their electronic remittance advice (ERA) through Essentials, so you’ll know how much you were reimbursed for care. We even offer secure messaging with attachments for many payers, so you can easily handle claim disputes without having to log into the payer’s proprietary site.
When there are overpayments you can easily accept or dispute the amount, send supporting documents, and exchange messages with the payer until the final amount is determined.
Several payers even let you enroll in electronic funds transfer (EFT), so not only do you know how much the reimbursement is, you can track the payment right into your bank account.
Sometimes, though, you need even more-detailed payer-specific information.
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Provider Information Management
Patients use provider directories—published by your payers—to find information about your organization. For Medicare, Medicaid, and exchange patients, it’s especially important that these directories be accurate and up to date. If you don’t regularly verify your organization’s information, a payer may choose to exclude it from their directories.
Helping providers and payers stay on the same page
Availity’s Directory Verification app in the Essentials platform lets you update your directory information online, using forms pre-populated with most of your information. You simply verify the information that’s correct, fix what’s wrong, and click the Submit button. Availity automatically sends your updates to payers who are working with us on their directories.
The app shares data with our new credentialing app, which many payers are using to simplify the credentialing and recredentialing process for providers. The new app takes minutes to fill out instead of hours, and shows you just where your application is in the process of verification, review, and approval.
Keeping you up-to-date is Availity’s central focus, and you can access some of the best-in-class reporting tools through Essentials.
View PDM FAQs
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