PPT 5010 Eligibility Benefits Base

8/3/2019 PPT 5010 Eligibility Benefits Base

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Eligibility and Benefits 5010

View this recorded webinar to learn about the changes comingto Availitys Eligibility and Benefits Inquiry with the upgrade to5010.

2011 Availity, LLC | All Rights Reserved1

Rev.06.30.2011.1


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What We Will Cover

5010 overview Eligibility and Benefits Inquiry overview

New in Eligibility and Benefits Inquiry

Preparation

Next steps

Additional information



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5010 Overview

5010 is an updated transaction version Legislative mandate requires migration by 1/1/2012

Availity is partnering with payers and vendors to migrate

This is a high-level view of the Eligibility and Benefits Inquirytransaction.


Tip: View the 5010 Overviewrecording before viewing thisand other transaction-specificrecordings.


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5010 Overview Web Portal Users

Web portal usersAvaility displays the correct version when you select the payer.



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5010 Overview EDI and B2B Submitters

EDI and B2B submittersAvaility converts your file to the right version for the payer andconverts responses back to you.


Providersubmitsrequest

Availity processes file:

Keeps file in submittedversion

Converts file to 4010

Converts file to 5010 Converts file to 5010A1

Payerprocesses

Payerresponds

Responses

returned insubmitted

version


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What We Will Cover Next Section



Preparation

Next steps




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Eligibility and Benefits Inquiry Overview

The Eligibility and BenefitsInquiry feature allows youto verify eligibility for apatient and confirm thebenefits covered underthe member's contract.

Because Availity connectsto multiple health plans,we can provide one, easyplace to check eligibility

and benefits at no charge.



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Steps to Eligibility and Benefits Inquiry

1. Click Eligibility andBenefits | Eligibility andBenefits Inquiry.

2. Select the payer and letthe page refresh.

3. Complete the requiredfields and click Submit.

4. View the results.

Click Print.

Click Edit Inquiry.

5. Click View Details.

6. Click View Summary.


Tip: Click the Help link or oneof the blue question marks formore information.


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Preparation

Next steps




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Whats New



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New Features Organization Field


4010

Displays in the ProviderInformation section.

5010

Displays below the Payer field.

Differences in the Organization field placement:


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New Features Add Provider Link


4010

Add Provider button

5010

Add Provider link in newlocation

Differences in the Provider Information section:


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New Features ID Fields


4010

Multiple ID fields

5010

Only the required ID fielddisplays

Differences in the Provider Information section:


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New Features Calendar Tool


5010 new features

Calendar icon for date fields

In the Patient Information section:


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New Features Benefit/Service Type


4010

Type of Benefits Requestedfield

5010

Benefit /Service Type field

In the Patient Information section:


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New Features Benefit/Service Type


4010

All patient information fieldsdisplay on page

5010

Options for patient informationfields

Important fields in the Patient Information section:


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New Features Clear Button


The Clear Page button is nowthe Clear button. Thefunctionality is the same.

4010

5010

The buttons at the bottom of the page:


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Eligibility & Benefits (E&B) Summary Results

The same sectionsdisplay on the 5010Eligibility & BenefitsSummary Results.

Health Benefit PlanCoverage

SubscriberInformation

Plan/ProductionInformation



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E&B Results, cont.

Primary CareProvider

Pre-ExistingInformation

Non-Covered

Services



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E&B Results, cont.

Other orAdditional Payer

The Service Typetable



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E&B Results IDs

The transaction ID and customer ID now display in the upperright of the results page.



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E&B Results View/Hide Messages

View/Hide Messages button



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E&B Results View More/View Less

View More buttons



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E&B Results Other or Additional Payer

Other or Additional Payer section



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E&B Results View Additional Benefits

View Additional Benefits link



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E&B Results Service Type

Service Type table

Value adds



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E&B Detail Results Service Type

Expanded Service Type sections:

Co-Payment

Co-Insurance



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E&B Detail Results Service Type, cont.

ExpandedService Typesections:

Deductible

Limitations



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E&B Detail Results Service Type, cont.


Expanded ServiceType sections:

Out of Pocket(Stop Loss)

Contact Following

Entity for Eligibilityor BenefitInformation

Payer ContactInformation


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5010 overview

Eligibility and Benefits Inquiry overview


Preparation

Next steps




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Preparation Maintain Provider

For Eligibility and Benefits Inquiry, update your providerinformation and NPI in Maintain Provider.

In the Availity portal, click My Account | Maintain Provider.

Your billing provider must have a physical address for Websubmissions.

Your billing provider and service facility address must includean accurate ZIP+4. Access the U.S. Postal Service website tosearch for the correct code. http://www.usps.com/

http://www.usps.com/http://www.usps.com/


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Preparation Payer Differences

Remember, as payers upgrade, slightly different fields andoptions will display as you switch from payer to payer.



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5010 overview



Preparation

Next steps




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Next Steps Release Communication

Refer to Availity release communications to learn about payer-specific implementations.



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5010 overview



Preparation

Next steps




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Information Available Now


www.Availity.com/5010

www.GetReady5010.org

Access Availity.com/5010

Review industry-sponsored websitefor the changes coming in 5010


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Information Coming Soon


Play on-demandwebinars

Attend livewebinars

Quick TipGuides

Availity Help

Play recorded webinars to learn aboutchanges that apply to all payers

Attend live webinars detailing payer-specificinformation to help you transition to 5010

Access printable PDFs with payer-specificinformation on each transaction

Review updates in Availity Help


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Thank you

Call 1-800 AVAILITY (282.4548)

Or visit us online at availity.com
http://www.availity.com/http://www.availity.com/

Documents

PPT 5010 Eligibility Benefits Base