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Focused on making your job easier, faster, and more productive ... October 2009

Availity User IDsDo you have your own Availity User ID? You should!

Availity requires each Availity user to have an individual user account with a unique

user ID and password. The reasons for this are both legal and practical.

The Legal – For Primary Access Administrators (PAAs)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was signed into law, in part, to ensure the security and privacy of individual health informa-tion. As a health care provider, your organization is required to adhere to the standards set forth by HIPAA. Providing each Availity user with a unique user ID is one important step you can take toward this goal. Unique user IDs help you to control and monitor Availity usage in your organization and help to ensure that unauthorized persons do not have access to protected health informa-tion (PHI).

You can quickly and easily set up user accounts for each Availity user in your organization. From the Availity menu, click Account Administration | Register New User.

The Practical – For Availity Users

There are a number of reasons why it makes your job easier to have your

own Availity user ID. For example, if you are sharing a user ID with a coworker:

• You cannot both log in to Availity at the same time. Availity allows only one instance of a user ID to access the system at a time.

• Keeping track of password changes can become unmanage-able. Your Availity password changes over time and becomes difficult to track if you are shar-ing your user ID. Here are some of the common reasons your password may change:

- Your Availity password ex-pires every 60 days and you must change it.

- Your PAA resets your password if your account becomes locked.

- You forget your current pass-word, so you change your password yourself.

- You decide you want a new password, so you change your password yourself.

• Availity Client Services may not be able to assist you with login problems. Availity Client Services must validate your identity before assisting you with any login problems. If you do not have your own user ID, Availity cannot validate your identity.

• You may not be able to change your password yourself should you forget the current one. Availity requires that you answer a security question before allow-ing you to change your password online. If you do not have your own user ID, you may not be able to answer the security question.

If you are currently sharing a user ID with a coworker, ask your PAA to create a unique user ID for you. Once you have your own user ID, you

continued as “User IDs” on page 2

Availity User IDs

For both legal and practical reasons, you must have your own user ID. This will be even more important when Availity enhances its security architecture.

Ask your PAA to create a unique user ID for you and start taking advantage of Availity self-service features.

User Quick Reference

PAA Quick Reference

2 Availity, L.L.C. All Rights Reserved. Confidential and Proprietary.

October 2009 Availity e-Focus

Availity e-FocusCareCollect, CarePrescribe, and CareCost Estimator are service marks (SM) of Availity, L.L.C.

CareProfile and CareRead are registered trademarks () of Availity, L.L.C.

For newsletter suggestions: feedback@availity.com

For customer support: support@availity.com

Availity, L.L.C.P.O. Box 550857

Jacksonville, FL 32255-08571.800.AVAILITY (282.4548)

Send an e-mail message to us using the Contact Us page

at: http://www.availity.com/about-availity/contact-us/

On June 15, 2009, Availity entered into a contract with

WellCare Health Plans, Inc., a managed care services provider that exclusively serves government-sponsored health care programs such as Medicare and Medicaid. This partnership enabled WellCare-contracted providers who are registered Availity users to submit secure, real-time health care claims to WellCare at no cost. This partner-ship benefits providers in Florida, Georgia, New York, Connecticut, New Jersey, Louisiana, Ohio, Texas, Illinois, Missouri, Indiana, and Hawaii. In August 2009, this part-nership was expanded so registered providers could also access secure, real-time eligibility and benefits transactions for WellCare members at no cost through the Availity Health Information Network.

“Through our expanded service agreement with Availity, WellCare-contracted providers have more timely access to important mem-ber health care eligibility and benefit information,” said Rex Adams, WellCare’s chief operating officer. “We have the privilege of serving nearly 2.4 million Medicare and Medicaid members nationwide,

Availity Partnership with WellCare Expands Real-Time Access for

Providerscan take advantage of the following Availity self-service features:

• Change your password at any time – On the Availity Log In page, enter your user ID and password. Then select the Check this box to change your pass-word after logging on check box.

• Change your password if you forget your current one – On the Availity Log In page, enter your user ID, and then click I forgot my password.

Don’t Delay

In the coming months, Availity will be enhancing its security architec-ture and it will become even more important to have your own user ID. So don’t delay…get your own Availity user ID today!

“User IDs” continued from page 1

and our partnership with Availity is one way we can improve care for our members and serve our providers more effectively and efficiently.”

The partnership is a result of Availity and WellCare’s commit-ment to improving patient care. The seamless exchange of information is expected to reduce costs for pro-viders while helping them deliver improved health care to nearly 2.4 million WellCare members.

About WellCare Health Plans, Inc.

WellCare Health Plans, Inc. provides managed care services exclusively for government-sponsored health care programs, focusing on Medicaid and Medicare. Headquartered in Tampa, Florida, WellCare offers a variety of health plans for families, children, and the aged, blind, and disabled, as well as prescription drug plans. The company served approximately 2.4 million members nationwide as of June 30, 2009. For more information about WellCare, please visit the company’s website at www.wellcare.com.

Availity, L.L.C. All Rights Reserved. Confidential and Proprietary. 3

Availity e-Focus October 2009

Humana Remittance now includes the

option to view and print a PDF

The Humana remittance review tool has been enhanced to

include an updated display and the following new features:

• Single Remit Download with a PDF option. Now you can view and print a PDF version of your Explanation of Remittance files. This option is in addition to the previous options to download 835 format, Word, and Excel versions of your files.

• Explanation of Remittance Downloads page. Track all Explanation of Remittance files that you have chosen to down-load and view their download status. Files display status as “running” during download and will change to “available” once they are complete. All files selected for download will be ac-cessible for 24 hours.

• Help Feature. The enhanced Humana Remittance Review now includes a new Help Feature that contains frequently re-quested help documentation spe-cific to the Remittance Review function.

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Significant improvements in processing efficiency and response times for Electronic Remittance Advice (ERA) files

By popular request, an aggrega-tion feature is now available for

ERA delivery. This setting enables users to receive all of their remit-tances in a single file, instead of managing separate files for each payer and tax ID. Detailed descrip-tions of the various aggregation methods and associated outbound file names are included in the New ERA File Process Specifications.

• Ability to change ERA prefer-ences for aggregation and other delivery settings on the EDI Reporting Preferences page.

• Streamlined file processing and faster turnaround for reloading ERA files, upon user request. Note: Although Availity’s ERA file processing has changed, the

process for requesting an ERA file reload has not changed.

Please review the New ERA File Process Specifications for a detailed explanation of the aggregation methods supported by the new file process and the associated outbound file names. Please consult with your practice management system vendor before making any changes to your options to ensure any chnages to ERA delivery that you make will not impact your automated posting process.

Access “ERA” help topics by click-ing Help at the top of any Availity page. For assistance, please con-tact an Availity Client Services Representative at 1.800.AVAILITY (282.4548), Monday – Friday, 8:00 a.m. – 7:00 p.m. (ET) or contact us on the web.

New ERA File Process Specifications

4 Availity, L.L.C. All Rights Reserved. Confidential and Proprietary.

October 2009 Availity e-Focus

New: Claim Research Tool available for BCBSIL, BCBSNM, BCBSOK, BCBSTX

Our new online Claim Research Tool (CRT) provides your

office staff greater claims accuracy and increased office efficiency in managing your accounts receivable. The CRT gives your staff fast, real-time access to enhanced claim status information for Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas*, along with features that include:

• Status of multiple claims in one view

• Member ID and claim number look-ups

• Patient account and group num-ber information

• Detailed line-level informa-tion including reason codes and descriptions

• Related copay, deductible, and coinsurance amounts

For more information, click Help at the top of any Availity page and read the “Submitting Claim Research Inquiries” help topic.

The CRT also ends the need for costly, time-consuming phone calls to research claim detail. The Tip Sheets (below) make using this great new tool a breeze. Best of all, the CRT delivers all of the above at no cost to you!

• BCBSIL Tip Sheet

• BCBSNM Tip Sheet

• BCBSOK Tip Sheet

• BCBSTX Tip Sheet

* Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Texas, Blue Cross and Blue Shield of New Mexico and Blue Cross and Blue Shield of Oklahoma are Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.

Where’s Availity?Availity will attend these events:

• eSolutions Vendor Workshop – 11/4, Chicago, IL (e-mail Provider_Relations@hcsc.com or call Provider Relations at 312.553.4019)

• World Healthcare Innovation and Technology Congress – 11/8-11/10, Washington, DC (http://www.worldcongress.com/)

Eligibility and Benefits for WellCare Health Plans

Availity now supports seamless vendor integration, or business-

to-business (B2B) integration, for Eligibility and Benefit Inquiry (E&B) transactions with WellCare’s various health plans.

Contact your practice management system vendor today and ask if they support B2B transactions with Availity for WellCare or visit the Availity technology partners list at www.availity.com.

Availity, L.L.C. All Rights Reserved. Confidential and Proprietary. 5

Availity e-Focus October 2009

Upcoming Availity WebinarsTo register for a live webinar, click Free Training on any Availity page and follow the instructions on the Availity Training page. Webinars are added regularly. Check the Availity Training page often for updates.

Webinar Region(s) Date Time Length (min.)

Availity 101: An Introduction to Availity for AHIP Providers

IL, NM, OK, TX

11/3 10:30 am (CT), 11:30 am (ET) 60

Claim Research Tool (CRT) All 11/3 2:00 pm (CT), 3:00 pm (ET) 60Availity 101: An Introduction to Availity for VHEN Providers

All 11/4 10:30 am (CT), 11:30 am (ET) 90

CareCollect: Payment Processing to Meet Your Needs

VA 11/10 1:00 pm (CT), 2:00 pm (ET) 90

Primary Access Administrator (PAA) Training

FL, TX, KY

11/11 11:00 am (CT), 12:00 pm (ET) 60

Availity 101: An Introduction to Availity for AHIP Providers

VA 11/11 1:00 pm (CT), 2:00 pm (ET) 90

Availity 101: An Introduction to Availity for New Users

All 11/12 11:00 am (CT), 12:00 pm (ET) 60

Availity 101: An Introduction to Availity for VHEN Providers

OH 11/12 1:00 pm (CT), 2:00 pm (ET) 90

CarePrescribe: Availity’s ePrescribing Solution

FL, TX 11/13 1:00 pm (CT), 2:00 pm (ET) 60

Authorizations & Referrals Training OH 11/16 1:00 pm (CT), 2:00 pm (ET) 90CareCalc: Estimate Your Patient’s Financial Responsibility

All 11/16 1:00 pm (CT), 2:00 pm (ET) 60

Facility Web Claims Submission & Inquiry

All 11/17 9:30 am (CT), 10:30 am (ET) 60

EDI Training for Availity EDI Submitters All 11/18 11:00 am (CT), 12:00 pm (ET) 105Eligibility & Benefits Inquiry Training All non-FL 11/20 10:00 am (CT), 11:00 am (ET) 75Professional Web Claims Submission & Inquiry

FL, TX, KY

11/23 10:00 am (CT), 11:00 am (ET) 60

Eligibility & Benefits Inquiry Training FL 11/23 12:30 pm (CT), 1:30pm (ET) 75CareProfile: Electronic Health Records at Your Fingertips

FL 11/24 10:00 am (CT), 11:00 am (ET) 60

CareProfile: Electronic Health Records at Your Fingertips

All 11/30 11:00 am (CT), 12:00 pm (ET) 60

* The webinar schedule is subject to change.

6 Availity, L.L.C. All Rights Reserved. Confidential and Proprietary.

October 2009 Availity e-Focus

Availity e-Focus Crossword PuzzleClick the Print icon in the Adobe Reader toolbar to print the newsletter or just the crossword. Unless hints are noted, you can find answers scattered throughout this issue. The solution will be published in the next issue.

Down1. Availity now supports B2B _____ for the eligibility and benefits

inquiry transactions with WellCare’s health plans.

2. BCBSIL, BCBSNM, BCBSOK, BCBSTX providers can now enjoy greater efficiency in managing accounts receivable with the _____ tool. (2 words)

5. Humana Remittance now includes the option to view and print a _____.

6. By popular request, Availity now offers an _____ feature for ERAs.

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Across3. Providers in twelve states now

have free access to real-time eligi-bility and benefits transactions for _____ members.

4. Each Availity user must have his or her own unique _____. (2 words)

5. To receive all remittances in a single file, update the ERA set-tings on the EDI Reporting _____ page.

7. Ask your _____ to create a unique user ID for you.

8. Having your own unique user ID is one important step you can take toward adhering to _____ standards.

9. To find more information on ag-gregation methods for ERAs, review the new ERA File Process _____.