Availity Essentials

Keeping in mind provider feedback and the future vision of Highmark’s digital platforms, we evaluated the advantages of our current provider portal and areas where we can improve. We looked closely at our opportunities to offer an enhanced online experience and found that Availity meets many of the criteria that will help us better serve you.

Availity’s expertise is in building and managing a provider portal with tools that are easy and useful to health care providers. The company continually seeks provider feedback to improve its website for all users. Benefits include:

• A single login and password that lets you check eligibility and benefits or the status of a claim for patients with coverage from multiple health plans without logging into different systems.
• Customized tools within Availity for Highmark information that will better meet your needs.
• Express Entry that lets you set up specific providers in the system so you can click on them from a dropdown menu and have information automatically populate. This means you don’t have to retype data, such as NPI numbers or provider names.
• Access to Highmark-specific resources through a dedicated payer space.

• Highmark Blue Cross Blue Shield (DE)
  
• Highmark Blue Cross Blue Shield (WNY)
  • New York state plans already use Availity for its Medicaid and CHP lines of business. Now Commercial, FEP, ACA and Medicare Advantage plans will be added.
• Highmark Blue Cross Blue Shield (WPA/NEPA)
  
• Highmark Blue Cross Blue Shield (WV)
• Highmark Blue Shield (CPA/SEPA)
• Highmark Blue Shield (NENY)

Highmark Wholecare and Highmark Health Options will not transition to Availity; providers should continue to use their current portals for transactions related to these plans.

There is no cost to providers to access it.

If your organization is already registered with Availity, you do not need to re-register. You may only need to review the Highmark-specific features.

If your organization is not already registered with Availity, you should register for access now (or as soon as possible). 

Availity

For details, go to the link below

Register and Get Started with Availity Essentials webpage.

Highmark is available to you as a payer in the dropdown menu, listed as one of the following depending on which Highmark plans you are contracted:

• Highmark Blue Cross Blue Shield (DE)
• Highmark Blue Cross Blue Shield (WNY)
• Highmark Blue Cross Blue Shield (WPA/NEPA)
• Highmark Blue Cross Blue Shield (WV)
• Highmark Blue Shield (CPA/SEPA)
• Highmark Blue Shield (NENY)
  

If you have access to more than one state or region, be sure to first select the appropriate state from the dropdown menu located in the top navigational bar on the Availity Essentials home page. For example, selecting Pennsylvania will allow access to all available Pennsylvania payers, including Highmark Blue Shield (CPA/SEPA) and/or Highmark Blue Cross Blue Shield (WPA/NEPA).

If you’re already registered with Availity, you will use the same Availity username and password you use today.

With Availity, an individual in your office or facility serves as the administrator. That individual can register with Availity online. The office administrator can begin the registration process on the Register and Get Started with Availity Essentials webpage. After registering an organization, the administrator can add other users from the administrator’s organization.

To learn more about registering and getting started with Availity, go to the Register and Get Started with Availity Essentials webpage.

If you need assistance with an existing account or have started the registration process and are experiencing issues, you can contact 800-AVAILITY (282-4548), Monday through Friday, 8 a.m. to 8 p.m. Eastern time.

Providers who are not currently registered to use Availity should register now. 

To register:

• Select someone in your organization (office, practice, or facility) to serve as the primary Availity administrator. This person will handle access to Availity for other users, speeding up the enrollment process. The primary Availity administrator will be able to add team members or change access with just a few keystrokes.
• The organization should also delegate some team members to assist the primary Availity administrator. These individuals can handle requests when the primary Availity administrator is not available.
• For the best experience and a smooth transition to Availity, review the technical requirements for optimum performance.
  • You can find these requirements on the Availity website. Scroll down and click on the Requirements tab.
• Your Availity administrator should register at availity.com by clicking on Create an Essentials Account in the upper right corner of the screen. After registering the organization, the administrator can add other users and assign access roles.
  • To learn more, go to the Register and Get Started with Availity Essentials webpage.

For guidance on how to set up your organization, please review our Manage My Organization user guide.

One person can be the administrator for multiple organizations, and that administrator still has only one user ID and password which is the same for all the organizations he or she manages. The administrator assigns users to the organizations. Each individual user has his/her own unique user ID and password, and each individual provider entity has its own profile.

Large organizations can elect to register separate Availity accounts for distinct locations and/or departments or they can choose to have only one account. While organizations can have only one primary administrator for Availity, that administrator can assign the User Administration role to other users who can then assist with adding and editing users and user roles. View the Register and Get Started with Availity Essentials webpage for more information or call 800-AVAILITY (282-4548) for individual assistance.

If you do not currently work with Availity, you will need to register with Availity as a billing service. Then, you’ll need to add your providers to your profile.

Current users automatically have access to Highmark information as we roll out access throughout the transition process (See fourth question for timeline). The only action an Availity administrator would need to take is when users have a different role within Availity for their Highmark work compared to their role within Availity for other payers.

Availity has recorded webinars for you to view.

• Log into Availity.
  
• Go to the Help & Training tab on the homepage.
• Click Get Trained from the drop-down menu to view recorded demos and webinars. 

Highmark Training Courses

Availity also has Highmark-specific training courses available.

• Log into Availity.
• Select Help & Training tab on the homepage.
• Click Get Trained from the drop-down menu and search “Highmark” to view recorded demos and webinars. (Direct links below.)
  • Availity Essentials Introduction for Highmark Providers - Recorded Webinar
  • Claim Submission for Highmark Providers - Recorded Webinar
  • Claims Follow-up & Payment Applications for Highmark Providers - Recorded Webinar
  • Quick Claims for Highmark Providers - Recorded Webinar

Crosswalk Document

This Crosswalk document will show you how to find all the Availity tools and functions you need to work with Highmark.

Crosswalk Document

*NOTE: You must be registered with Availity to access the training resources mentioned above.

All Availity users can participate in training.

Yes, Highmark has resources available on the following topics:

Prior Authorization

The Obtaining Authorizations page of the Provider Resource Center includes guides and videos on how to submit electronic authorizations.

OBTAINING AUTHORIZATIONS

Electronic Claims Submission

The Electronic Claims page of the Provider Resource Center includes information on claim submission, status, and inquiries.

ELECTRONIC CLAIMS (SUBMISSION, STATUS, AND INQUIRY)

Availity Best Practices

The Availity Troubleshooting Guide includes helpful, how-to tips on setting up and using the following applications and/or functions in Availity:

• General Access and Support
• Payer Spaces Access
• Authorizations
• Eligibility and Benefits (E&B)
• Claims Inquiry
• Credentialing
• Reporting Access (Provider Facing Analytics and Quality Blue)

Highmark Training Courses

Availity also has Highmark-specific training courses available.

• Log into Availity.
• Select Help & Training tab on the homepage.
• Click Get Trained from the drop-down menu and search “Highmark” to view recorded demos and webinars. (Direct links below.)
  • Availity Essentials Introduction for Highmark Providers - Recorded Webinar
  • Claim Submission for Highmark Providers - Recorded Webinar
  • Claims Follow-up & Payment Applications for Highmark Providers - Recorded Webinar
  • Quick Claims for Highmark Providers - Recorded Webinar

Use Availity's Authorizations & Referrals for all initial authorization submissions.

Use the Predictal Auth Automation Hub to check authorization status, review approval and denial letters, manage discharges and concurrent requests, respond to requests for additional information, and submit extensions.

Additional guidance can be found under Obtaining Authorizations.

Yes, there’s a link to CoverMyMeds under "Applications" in Payer Spaces. Once at the CoverMyMeds site, you can log in with your current user credentials.

You have the ability to submit batch eligibility and benefit searches through Availity. 

Yes. To view member information in Availity, go to "Patient Registration" and then click "Eligibility and Benefits Inquiry."

Yes, the responses can be viewed by all staff in the organization. However, only the original submitter can reply to Highmark … unless the organization’s administrator reassigns the claim to another staff member.

Yes, Explanation of Benefits (EOBs) will be available on Availity for six months.

Users can to log into Helion Arc directly with their unique username and password to access Helion scorecards and reports and/or palliative, behavioral health, gap closure triggers.