JULY/AUG 2014

FEEDBACK? EMAIL US AT CORPCOMM@AVAILITY.COM

A news magazine for users of the Availity Web Portal

Healthy, sustainable growthEnsuring bigger is better

HEALTHY, SUSTAINABLE GROWTH It’s been a pivotal year so far for Availity—a key acquisition, new strategic partnerships, and the successful completion of a complex, large-scale migration project. Find out how this growth helps you.

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ContactFor newsletter suggestions: corpcomm@availity.comFor customer support: support@availity.com P.O. Box 550857 Jacksonville, FL 32255-0857 1.800.AVAILITY (282.4548)

JULY/AUGUST 2014

01

PULSE

ELIGIBILITY AND BENEFITS 04 REDESIGN

CEO NOTE 05

FOUR TOP FINDINGS FROM 06 RESEARCH ON ATTITUDES TOWARD VALUE-BASED PAYMENTS

HEADLINES 08

WHAT’S NEW 09

EVENTS & TRAINING 10

Availity Pulse July/August 1

It’s been a pivotal year so far for Availity—a key acquisition, new strategic partnerships and the successful completion of a complex, large-scale migration project with Anthem Blue Cross & Blue Shield plans that means we’ve welcomed more than 62,000 new provider sites in four states this spring. Now at the end of the two-year migration, the Availity Web Portal has replaced Anthem’s existing provider portals for affiliated health plans in 14 states, along with 13 additional plans and government plans across the country.

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HEALTHY, SUSTAINABLE GROWTHSee how we’ve grown to give you more of the good stuff

Availity Pulse July/August 2

Welcome to the family

We’re excited to welcome new users in California, Colorado, Nevada and New York to the Availity Web Portal. If you’re in one of these states, we hope you’re starting to see how the portal can streamline your everyday tasks.

Did you know Availity offers several features not available via Anthem’s previous ProviderAccess®? Take a minute and check out what the Availity Web Portal can do for you:

Interactive care reviewerInitiate inpatient and outpatient precertification requests more efficiently and conveniently

Secure messagingSubmit a question via secure email to clarify the status of a claim or to get additional information on claims

Patient care summaries View a real-time consolidated snapshot of a member’s medical history based upon claims information across multiple providers

Care reminders Receive clinical alerts for patient care gaps and medication compliance indicators, when available

Member certificates of coverage View specific benefit details by accessing the member booklet/certificate of coverage

Whether you’re a new user or just need a refresher, assistance is just a phone call or email away. 1.800.282.4548 | support@availity.com

Availity has teamed up with PaySpan Inc., a provider of health care reimbursement and payment automation services, to integrate PaySpan’s platform for electronic provider reimbursement with Availity’s solutions. The collaboration brings together health care and financial services to improve efficiency, lessen

the complexity of reimbursement throughout health care and reduce operating expenses. Availity and PaySpan will launch the new service mid-to-late 2014 with the full PaySpan platform for electronic provider reimbursement and Patient Centered Financial Home™ solutions. Read the news release.

Partnering for simpler and faster reimbursement: Availity + PaySpan

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Availity Pulse July/August 3

In another strategic collaboration, Availity is working with emids, a health care-focused technology services and solutions organization, to establish a technology center for Availity in Nashville, Tenn. Together, emids and Availity will

accelerate the development of new products, to deliver enhancements and new technologies to customers even more quickly than before. Read the news release.

Partnering for faster new product development: Availity + emids

Amerigroup* eligibility, benefit and claim status information is now available on the Availity Web Portal for certain states. The move to Availity for these functions provides you with access to real-time information and instant responses in a consistent format, regardless of the payer. Start exploring how you can use the Availity Web Portal during your patient check-in, during checkout or billing, or whenever you might benefit from easy, instant access to health plan information.

States that have transitioned eligibility and benefits and claim status inquiry functions to

the Availity Web Portal include Florida, Kansas, Louisiana, Maryland, New Mexico, Nevada, New Jersey, New York and Washington. Welcome!

Another new addition to the family: Amerigroup

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*In Louisiana, Amerigroup Louisiana, Inc. and in Washington, Amerigroup Washington, Inc.

Availity Pulse July/August 4

We’re making changes in the Web Portal to help you work smarter. If you’ve been a long-time user, you’ve probably noticed that finding your favorite benefit/service types for eligibility and benefit inquiries has recently gotten easier. We’ve added a custom drop-down menu that remembers your organization’s top five most frequently used selections and displays them at the top of the list—reducing search time. This new menu completes the first phase of the eligibility and benefits refresh project, as we described earlier this spring.

In the coming months, you’ll see an all-new results page featuring a revamped layout complete with new menus, color scheme and categorization to make the information you need easier to locate. Plus, we’re introducing a view/print all capability and a transaction history feature. It’s all part of enhancing your overall experience with eligibility and benefits in the portal.Nearly 126,000 of you (to date) have been asked to give

ELIGIBILITY AND BENEFITS REDESIGNMore than just window dressing

input on proposed changes, in an online survey featuring a preview of the new look. We’re very interested in what you have to say—your input may help shape the portal’s future. We’re listening and will continue to improve the Web Portal based upon your feedback.

We’re listening—stay tuned for updates to the E&B layout that will make your job easier.

Above is an example of a Web Portal user’s most frequently used benefit selections, a new time-saving feature that is visible within the eligibility and benefits menu

Availity Pulse July/August 5

You may have heard that Availity recently acquired RevPoint, a Nashville, Tenn.-based company that helps health care businesses succeed in their patient collection processes. This unique patient collections product, now known as Availity Patient Access, is available to all of our customers. We would love to show it to you. And while we’re happy to share the news that we’re growing, the really important part is why.

Our job is to make you more successful than you already are. We recognize that a successful physician/patient relationship includes collecting from patients at the beginning of the revenue cycle process, which can be challenging, at best, in today’s complex payment environment. The health care market is transforming quickly, shifting significant responsibility for payment to consumers. With that, both patient liability and bad debt are on the rise. Your business needs updated systems to enable significant process improvements and a way to integrate patient payments into your workflow, and we’ve acquired RevPoint to help you get there.

Historically, most payment collection activities have occurred long after the patient has left the facility—which creates back-end work that can significantly delay payment. But today’s savvy medical businesses are placing a new importance on revenue capture at time of service. Between health care reform, the growth of high-deductible health plans and decreasing reimbursements, we know you have to get better on the patient payment side to succeed in your business.

We’re growing to help you succeed

A NOTE FROM OUR CEO

Our new Patient Access solution gives you all the tools you need to move your patient collection efforts upstream, so you can have more timely and consistent cash flow. Availity’s expertise in provider workflows supporting the billing and reimbursement processes will be enhanced with this solution for early-cycle reimbursement, giving you a full suite of patient access tools for improving your business performance.

As always, Availity is working hard to continue earning your business by helping you build a healthy business. The acquisition of RevPoint, and our introduction of Patient Access to our clients, is another example of our commitment to your success.

Respectfully,

Russ Thomas

Availity’s new Patient Access solution allows providers to collect patient payments at the beginning of the revenue cycle.

Availity Pulse July/August 6

By Brian Kagel, director of market research and customer experience insights, Availity

If you’re like most providers, you participate in at least one value-based payment model. And you’re participation in these models is likely to increase over the next few years.

So where exactly is all this going? While we don’t have a crystal ball, we do know that gaps and barriers affecting the scalability of ACOs, patient-centered medical homes and other value-based payment models have become an important part of that discussion.

Operational uncertainty plays a major role in the industry’s confidence regarding value-based payments—particularly among providers—but we wanted to find out more specifics on what is hindering further growth and adoption. To find out, Availity

FOUR TOP FINDINGS: New research on attitudes toward value-based payments

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While 75% of providers currently participate in at least one value-based payment model, and more than 60% expect them to become the dominant payment model, fewer than 30% believe they offer a good level of reward for the risk.

30%of providers believe that value-based payments offer enough reward for the risk

Availity Pulse July/August 7

undertook a research study to learn more about current-state adoption, gauge current provider attitudes, and identify barriers and concerns, all from the provider perspective.

I encourage you to check out the complete research report, “Provider Attitudes Toward Value-Based Payments,” which is packed with insights on these topics. In the meantime, check out the four key takeaways at the left.

Because you need trusted, timely information to develop strategic plans that advance your business, Availity plans to continue to conduct and publish research on key issues. So be on the lookout for future research on this and other important topics.

Provider engagement in value-based payments exceeds growth expectations, increasing the already high pressure on operations and staff. At least three-quarters of providers participate in one or more value-based payment models, in addition to traditional fee-for-service models. Yet only about one quarter agree that value-based payment models make it easy to understand, track and project revenue.

1

Attitudes toward value-based payment models are mixed, reflecting uncertainties and provider concerns. Just 30 percent of providers believe that value-based payments offer enough reward for the risk. Half agree that value-based payment models will positively affect health outcomes and cost.

2

Despite the uncertainties, and while value-based payments represent only a small percentage of current revenue, providers anticipate strong growth. Twenty percent of provider revenue currently comes from value-based models, but 60 percent believe value-based payments of some type will become the dominant model.

3

Sustainable growth requires a focus on—and resolution of—data concerns, staff acceptance issues and operational integration problems. More than 75 percent of physician practices and hospitals agree that real-time information sharing will be critical for success. More than 80 percent cite the need for additional staff and time to manage value-based models.

4

Do you agree value-based payment programs offer a good reward/risk balance?

Why or why not? Tweet us and let us know! @Availity

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Availity Pulse July/August 8

6/02/14 Availity acquires RevPoint, adds Patient Access capabilities for hospitalsAvaility has acquired Nashville, Tenn.-based RevPoint Healthcare Technologies, an innovative provider of revenue cycle tools that increase patient collections at the beginning of the revenue cycle process. Read more

5/15/14 Availity achieves outstanding first quarter growthSales of Availity’s revenue cycle management solutions increased by 30 percent in new physician customers, with revenue bookings growth of nearly 60 percent as compared to the first quarter last year. The strong growth was bolstered by the demand for tools to help physicians manage revenue cycle changes related to government mandates, and by the market shift to value-based payment models. Read more

As of June 21, 2014, Anthem providers must go through the Availity Web Portal to access the MyAnthem portal for online remits, fee schedules and other static content. This new, single sign-on process allows users to register and access both Availity and MyAnthem quickly and efficiently, while eliminating the need to log into two separate portals.

MyAnthemSM ACCESSExclusively through the Availity Web Portal for IN, KY, MO, OH, WI

Due to the change, users log in via the Availity Web Portal rather than directly to MyAnthem, and then navigate from the portal to MyAnthem. Note: MyAnthem users still need to be registered with a user name, but no longer will have a password for MyAnthem.

Effective Aug. 2, Blue Cross and Blue Shield of Minnesota is moving online verification of member eligibility, benefits and claims status functions exclusively to Availity.

PROVIDERHUB TRANSITIONS KEY SERVICES TO AVAILITYBCBSMN users can access key functionality two ways

HEADLINES

After Aug. 2, users will be able to access clear claim connect, create a referral/admission, find a practitioner/facility, medical policy and find member case functionality through both Availity and ProviderHub.

Availity Pulse July/August 9

WHAT’S NEW

The Availity Web Portal was updated in May and June to enhance your experience and improve functionality.

Humana code edit simulator link available Availity now offers Humana providers a link to the Humana code edit simulator tool. You can reach this tool via the Availity Web Portal and run a simulated claim submission. Each simulation validates diagnosis and procedure code combinations to prevent errors in actual claims. This results in faster adjudication and payment.

To access this featureFrom the Availity menu, follow these steps: 1. Click Claims Management | Code Edit Simulator. 2. Click I Agree. 3. Accept the Humana disclaimer and then follow the site

prompts.

Authorization, referral, and auth/referral inquiry enhancement Avoid unnecessary typing (and keying mistakes!) by clicking a single check box to save new provider information on a referral, inpatient/outpatient authorization or authorization/referral inquiry form. This feature is available to all users for single or batch file submissions.

Payer ID changesUse the Availity Web Portal Payer List to see the health plans to which you can submit claims at no charge, plus additional transactions they support. Click Availity Payer List | Payer List in the Availity menu.

Cancellation of Medicare payer IDsEffective Oct. 1, 2014, Availity will no longer accept electronic claims with the cancelled Medicare payer IDs indicated in the chart below. Instead, electronic claims must have the CMS-assigned payer IDs or they will be rejected. Start updating your practice management system with these payer IDs to ensure your Medicare claims are processed properly.

Payer Name Can

celle

d

Paye

r ID

CM

S-A

ssig

ned

Pa

yer I

D

Alaska Medicare Part B 00831 02102

Arizona Medicare Part B AZ001 03102

Colorado Medicare Part B 04102 04112

DMERC Region D 05655 19003

Illinois Medicare Part B 00952 06102

Michigan Medicare Part B 00953 08202

Minnesota Medicare Part B 00954 06202

New Mexico Medicare Part B 04202 04212

Oklahoma Medicare Part A 04301 04311

Oklahoma Medicare Part B 04302 04312

Oregon Medicare Part BOR001;

0083502302

Railroad Medicare C00882 00882

Texas Medicare Part A00400;

0400104411

Texas Medicare Part B00900; 04402

04412

Virginia Medicare Part B 00904 11302

Washington Medicare Part BWA001;

0083602402

Wisconsin Medicare Part B 00951 06302

For more information, review the What’s New and Changed help menu topic. Read full release communications in our Knowledge Base.

Availity Pulse July/August 10

EVENTS

From webinars to trade shows to career events, we’re coming to a city near you.

July 23 Duluth, Minnesota Minnesota Medical Group Management Association

July 14 11:00 AM – 3:00 PM EST Indianapolis, Indiana

Indianapolis Veteran Job Fair

August 21 11:00 AM – 3:00 PM EST Indianapolis, Indiana

Recruit Indy Alumni Career Expo

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