How to Use Provider Data Management Tools in Availity

Transcription

1 September 2017 How to Use Provider Data Management Tools in Availity Florida Blue conducts all provider data activities through Availity 1. Please refer to the Table of Contents (with embedded links) below for detailed information. Note: You should only select the Create a Provider Record with Florida Blue to Submit Claims option if you or the entity you wish to register does not already have a Florida Blue provider number. Topic Access Brief Description Audience Create a Provider Record with Florida Blue to Submit Claims Registration Helpful Tips Must be registered with Availity Create an identity with Florida Blue (required to submit claims) Documents Required New Individuals Groups Businesses Facilities New Provider Added to Existing Group Access, Manage and Verify your Record View and Update Provider Information Helpful Tips Must be registered with Availity and either be assigned the role of Administrator (PAA) OR have been granted 720 Role Access by your administrator. The ability to view your existing record and make updates, including Directory verification. Required: Florida Blue ID and the SSN/TIN associated with that Florida Blue ID Documents Required New Individuals Groups Businesses Facilities Online Provider Directory Verification (Required by CMS) Online Provider Directory Verification Helpful Tips Must be registered with Availity and either be assigned the role of Administrator (PAA) OR have been granted 720 Role Access by your administrator. CMS mandates that providers verify/update their information quarterly (at a minimum) Availity generates a Notification with a link to Directory Verification. You will also be prompted at login to maintenance to conduct Directory verification. All Participating Providers New Individuals Groups Businesses Facilities 1 Availity, LLC is a multi-payer joint venture company. For more information or to register, visit Availity s website at Availity.com.

2 Request to Join our Networks Request to Join Our Network Helpful Tips Must be registered with Availity and either be assigned the role of Administrator (PAA) OR have been granted 720 Role Access by your administrator. The ability to submit a request to participate in our Florida Blue networks Required: Florida Blue ID and the SSN/TIN associated with that Florida Blue ID Documents Required New Individuals Groups Businesses Facilities How to Register with Florida Blue Provider DOES NOT have a Florida Blue Number Action Required or Issue Options or Tools in Availity Enroll a provider to obtain a Florida Blue number and have the ability to submit claims to Florida Blue. Important Note: A provider should only take this action ONE time. If a provider already has a Florida Blue provider number, this action does not apply. 1) Go to Availity.com to access the self- service tools. 3) Select Create a Provider Record with Florida Blue to Submit Claims to begin the enrollment process. Enroll a provider to obtain a Florida Blue number for an Organization (Supplier Business). 1) Go to Availity.com to access the self -service tools. 3) Select Create a Provider Record with Florida Blue to Submit Claims to begin the enrollment process. 4) Determine the type of provider you are enrolling. Are you an Organization (Supplier Business)? An Organization (Supplier Business) is defined as one of the following: Urgent Care Center Independent Diagnostic Testing Center Lab Durable Medical Equipment If yes, select I am an Organization such as an IDTC, UCC, DME, Lab, etc. Then select Provider Type = Non-Physician Group/Business.

3 Enroll a provider or practitioner using a New Direction Behavioral Health tax identification number. Behavioral Health How to Register with Florida Blue Provider DOES NOT have a Florida Blue Number Action Required or Issue Options or Tools Required in Availity Enroll a provider to obtain a Florida Blue Number for a Facility. 1) Go to Availity.com to access the self -service tools. 3) Select Create a Provider Record with Florida Blue to Submit Claims to begin the enrollment process. 4) Determine the type of provider you are enrolling. Are you a Facility? A Facility is defined as one of the following: Hospital Ambulatory Surgery Center Skilled Nursing Facility Dialysis If yes, select I am a Facility such as a Hospital, Dialysis, ASC, SNF, etc. Unable to find your specialty/taxonomy in the drop down list in Availity Note: The Network Management Service Unit cannot provide you with a taxonomy code. Please call the Network Management Service Unit at (800) to complete this request. You will be asked for an Availity Transaction ID. Say, I don't have one." You may be asked to enter your NPI. After entering your NPI, listen carefully to the prompts and say Contract Inquiry to get to the Network Management Service Unit. 1 Availity, LLC is a multi-payer joint venture company. For more information or to register, visit Availity s website at Availity.com.

4 Group practice is enrolling a provider who does not currently have a Florida Blue number, and is affiliating that provider to the group practice (affiliate to group) for the first time, AND: Service Location Not Found displays If the service location of the provider does not display as a location to select, you have the following options: 1) Proceed with enrollment (registration) application Select an existing service location (all locations in the group record are displayed) Upon submission of the enrollment (registration) application, the requester can launch the View and Update Your Provider Information option from the Availity landing page Enter the group number and group EIN/TIN to view the group s information Add the location to the group record Modify the location for the individual. 2) Do not proceed with enrollment (registration)

5 Opt to return later to complete the registration Launch the View and Update Your Provider Information option from the Availity landing page Enter the group number and EIN/TIN to view the group s information Add the location to the group record Wait until the update is completed Once completed, return to Create a Provider Record with Florida Blue to Submit Claims to complete the registration Submit registration Click on the PRINT button to review a PDF summary of your request. Print or Save the Summary to your drive Close the window in order to enable the SUBMIT button to display Click SUBMIT to complete your registration How to Register with Florida Blue Provider already HAS a Florida Blue Number Action Required/Issue Option or Tool(s) Required Updating an inactive Florida Blue number Please call the Network Management Service Unit at (800) to complete this request. You will be asked for an Availity Transaction ID. Say, I don't have one." You may be asked to enter your NPI. After entering your NPI, listen carefully to the prompts and say Contract Inquiry to get to the Network Management Service Unit. Change an Employee Identification Number 1) Go to Availity.com to access the self - (EIN)/Tax Identification Number (TIN) for a service tools. provider who has a Florida Blue number and is contracted with Florida Blue. 3) Select Create a Provider Record with Florida Blue to Submit Claims to begin the enrollment process. Add a new NPI number for a provider who has a Florida Blue number 1) Go to Availity.com to access the self-service tools

6 Add or change an Employee Identification Number (EIN)/Tax Identification Number (TIN) for a provider who has a Florida Blue number Update demographic information for a provider who has a Florida Blue number and wishes to update basic demographic information Add, edit or expire a specialty when the provider has a Florida Blue number. 3) Select the Access, Manage and Verify your Record tool. 4) Click on the "Provider Information Details or Practitioner Information Details" topic. Note: If the "Access, Manage and Verify your Record" link is not available, please contact your Provider Access Administrator to set your rolebased permission. Staff list/roster maintenance: Add, modify or delete associated staff list members for a provider who has a Florida Blue number. *This action replaces the PA form that was used before self- service tools became available. 1) Go to Availity.com to access the self -service tools. 3) Select the Access, Manage and Verify tool. 4) Click on the "Provider Staff List & Affiliation" topic. To complete your roster maintenance for adding a practitioner/physician, you are required to provide the following practitioner or nonphysician credentials: Florida Blue number and DOB, or SSN only Once you click Add to Roster, the affiliation is not complete. You must look for the practitioner/physician you added (displays in red text) and then click Update to complete. Note: If the "Access, Manage and Verify your Record " link is not available, please contact your Provider Access Administrator to set your role- based permission (720 role).

7 Request to Join Our Networks Provider already HAS a Florida Blue Number Action Required/Issue Option or Tool(s) Required Join Our Networks when the provider has a Florida Blue number. Select the Request to Join the Florida Blue Networks tool. Note: If the link to tool is not available, please contact your PAA to set your role- based permission. Accessing your record in the Access, Manage and Verify your Record provider information option (Maintenance) It s important to enter the correct payee ID associated with the Florida Blue number to access your record. If your record is not found, and you know the provider has a Florida Blue number, please do not attempt to re-enroll. Please verify your credentials and try again. Access, Manage and Verify your Record Provider already HAS a Florida Blue Number Action Required/Issue Option or Tool(s) Required A group practice needs to update the NPI for an individual on their staff list. 1) Go to Availity.com to access the self -service tools. 3) Select the Access, Manage and Verify your Record tool. 4) Enter the individual practitioner s Florida Blue number Is your Claim Payee ID your SSN/ITIN? Select Yes and then enter the SSN for the individual practitioner. 5) Select the Practitioner Information Details topic.

8 Group needs to update the following data elements for an individual on their staff list: Service location Payment location Relationship start date, and Specialty with group 1) Go to Availity.com to access the self -service tools. 3) Select the Access, Manage and Verify your Record option. 4) Enter the group Florida Blue number and the EIN/TIN for the group. Note: Service location, payment location, office hours or contact information for the group must be maintained under the group, and not the individual practitioner record. Individual (not affiliated to a group), needs to update their information. 1) Go to Availity.com to access the self-service tools. 3) Select the Access, Manage and Verify your Record Tool. 4) Enter the Florida Blue number and the SSN for the individual. Is your Claim Payee ID your SSN/ITIN? Select Yes and then enter the SSN for the individual practitioner. View and Manage Your Provider Information Provider already HAS a Florida Blue Number Action Required/Issue Option or Tool(s) Required Individual affiliated to a group needs to update their demographic information (not specific to group.) Name change DOB, SSN, gender, ethnicity Individual primary specialty Individual NPI (Type 1) License/certification 1) Go to Availity.com to access the self-service tools. 3) Select the Access, Manage and Verify your Record Tool. 4) Enter the Florida Blue number and the SSN for the individual. Is your Claim Payee ID your SSN/ITIN? Select Yes and then enter the SSN for the individual practitioner.

9 Individual affiliated to a group needs to update the following data elements: Service location Payment location Relationship start date, and Specialty with group Contact group administrator to request your update. Note: Service location, payment location, office hours or contact information on behalf of the group must be maintained under the group and not the individual practitioner record. Individual affiliated to a New Direction Behavioral Health tax identification number. Behavioral Health I have completed my update, and do not see the submit button. Confirm that the topics displayed aren t highlighted in red. If a topic is highlighted in red, there is data in the topic that must be completed before you submit your request. Submit registration Click on the PRINT button to review a PDF summary of your request. Print or Save the Summary to your drive Close the window in order to enable the SUBMIT button to display How long will it take for my update to complete? Updates may take up to 30 business days.

10 Provider Directory Verification Action Required/Issue Option or Tool(s) Required Log into Availity>Florida Blue Payer Space>Access, Manage and Verify your Record. Login using your Florida Blue ID and the corresponding Payee ID At login, you will have the option to Verify your Directory Information or continue without. Select the Radio Button for Verify Directory and Continue. Requires the Administrator or 720 Role Required once every 90 days. You will receive notifications (or be asked at Maintenance login) to confirm your Directory information throughout the quarter until you confirm you have no changes/make updates and submit. You will see sections highlighted in red. Expand each section that is red. If no change is needed, move on to the next. If you make no changes check the box stating that you have no changes. If you make changes, confirm your update. Group needs to update the following data elements for an individual on their staff list: Service location Payment location Relationship start date, and Specialty with group 1) Go to Availity.com to access the self -service tools. 3) Select the Access, Manage and Verify your Record tool. 4) Enter the group Florida Blue number and the EIN/TIN for the group. Change an Employee Identification Number (EIN)/Tax Identification Number (TIN) for a provider who has a Florida Blue number and is contracted with Florida Blue. Note: Service location, payment location, office hours or contact information for the group must be maintained under the group, and not the individual practitioner record. 1) Go to Availity.com to access the self - service tools. 3) Select Create a Provider Record with Florida Blue to Submit Claims to begin the enrollment process. Documents Required to Complete Your Request

11 Create a Provider Record with Florida Blue to Submit Claims (Register with Florida Blue) License Document Copy Upload Provider Specialty Required Note: In some cases, certain provider types or practicing Independent Physiological Lab CLIA specialties need to provide a Labs(Clinical) CLIA copy of a license and/or Hearing Aid Center certification to complete the Pharmacy - Injectable enrollment request. Please Drug Supplier upload a copy of the Ambulatory Surgery appropriate document using the Center table on the right as a guide. The table identifies the practicing specialty and the Behavioral Health Unit Participation type of document that must be com uploaded and attached to the enrollment request. Community Mental Health Center Home Health Agency Hospice Hospital - Long Term Psychiatric Hospital Rehabilitation Facility Rehabilitation Hospital Rehabilitation Unit Participation com Behavioral Health

12 Residential Treatment Facility Skilled Nursing Facility Skilled Nursing Unit V.A. Hospital Home Health Agency Rural Health Center Portable X-Ray Substance Abuse Facility participation om participation om Create a Provider Record with Florida Blue to Submit Claims (Register with Florida Blue) Key Office Staff DOCUMENT UPLOAD REQUIRED Note: A government issued ID can be a driver s license, state issued ID, passport, etc. Key office staff information is required to complete self-service enrollment. You will need the following items: Medical director (if applicable) - SSN, government issued ID, and copy of the government issued ID Owner of business or corporation /provider - SSN, government issued ID, and copy of the government issued ID Office manager/billing manager (if applicable) or additional staff members (if applicable) - government issued ID, and copy of the government issued ID Note: Document should be saved as an image on your computer in PDF, PNG, JPG, or GIF format with the appropriate name. Confirm and Attest DOCUMENT UPLOAD To submit your request, the individual completing the request is required to complete the following: Enter the first and last name

13 REQUIRED Documents Required to Complete Your Request(continued) Note: A government issued ID can be a driver s license, state issued ID, passport, etc. Enter a government issued ID Upload a copy of the requester s government issued ID. Note: Document should be saved as an image on your computer in PDF, PNG, JPG, or GIF format with the appropriate name. Request to Join Florida Blue Provider Networks Confirm and Attest DOCUMENT UPLOAD REQUIRED Note: A government issued ID can be a driver s license, state issued ID, passport, etc. To submit your request, the individual completing the request is required to complete the following: Enter the first and last name Enter a government issued ID Upload a copy of the requester s government issued ID. Note: Document should be saved as an image on your computer in PDF, PNG, JPG, or GIF format with the appropriate name. View and Update Your Provider Information License Name Change Upload a copy of one of the following: Court order document DOCUMENT UPLOAD Divorce decree REQUIRED Marriage certificate Updated license License and Certification Documents Required to Complete Your Request License Documents Required View and Update Your Provider Information Note: In some cases, certain provider types or practicing specialties may require a copy of a license and/or certification to complete the enrollment request. Please upload a copy of the appropriate document using the table provided as a guide. The table identifies the practicing specialty, and the type of document required to be uploaded and attached to the enrollment request for submission. Provider Specialty Independent Physiological Lab Labs(Clinical) Hearing Aid Center Pharmacy - Injectable Drug Supplier Ambulatory Surgery Center Behavioral Health Unit Children's Hospital Community Mental Health Center Document Copy Upload Required CLIA CLIA participation om participation om

14 Home Health Agency Hospice Hospital - Acute Care Hospital - Long Term Lithotripsy Facility Psychiatric Hospital Rehabilitation Facility Rehabilitation Hospital Rehabilitation Unit Residential Treatment Facility Skilled Nursing Facility Skilled Nursing Unit V.A. Hospital Home Health Agency Rural Health Center Portable X-ray Substance Abuse Facility participation om participation participation