accordSlider.js

Provider self-service on Availity

Many of the tools you need - such as eligibility and benefits inquiry, claims submission, claims status inquiry, and authorizations - can now be accessed by logging into your account on the Availity Portal.

Find these tools on Availity:

Expand the options below for instruction on locating each tool.

Claims

To submit a claim:

  1. From the Availity home page, choose Claims & Payments from the top navigation.
  2. Select Type of claim from the drop-down menu.

Claims status inquiry

  1. From the Availity home page, select Claims & Payments from the top navigation.
  2. Select Claim Status Inquiry from the drop-down menu.

Claims status inquiry and claim appeal

To check claims status or appeal a claim:

  1. From the Availity home page, select Claims & Payments from the top navigation.
  2. Select Claim Status Inquiry from the drop-down menu.
  3. Submit an inquiry and review the Claims Status Detail page.
  4. If the claim is denied or final, there will be an option to dispute the claim. Select Dispute the Claim to begin the process. You’ll be redirected to the Payer site to complete the submission.

Clear Claims Connection

To use Clear Claims Connection:

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the health plan.
  3. From the Payer Spaces home page, select the Applications tab.
  4. Select the Clear Claims Connection tile.

Authorizations

To request authorizations:

  1. From the Availity home page, select Patient Registration from the top navigation.
  2. Select Auth/Referral Inquiry or Authorizations.

Prior Authorization Lookup Tool

To check if authorization is required:

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the health plan.
  3. From the Payer Spaces home page, select the Applications tab.
  4. Select the Prior Authorization Lookup Tool tile

Eligibility and benefits inquiry

To check member eligibility and benefits:

  1. From the Availity home page, select Patient Registration from the top navigation.
  2. Select Eligibility and Benefits Inquiry.

Member panel listings

Note: There’s a separate registration your organization’s administrator needs to complete to access this tool. Please see registration instructions in the "Registration for provider online reporting" section below.

To access member panel listings:

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the health plan.
  3. From the Payer Spaces home page, select the Resources tab.
  4. From the Resources tab, select Provider Online Reporting. If you don't see it in the list, select Next from the right-hand side at the bottom of the page.
  5. From the Provider Online Reporting page, select Member Panel Listings

Member Reports

Note: There’s a separate registration your organization’s administrator needs to complete to access this tool. Please see registration instructions in the "Registration for provider online reporting" section below.

To access member reports:

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the health plan.
  3. From the Payer Spaces home page, select the Resources tab.
  4. From the Resources tab, select Provider Online Reporting. If you don’t see it in the list, select Next from the right-hand side at the bottom of the page.
  5. From the Provider Online Reporting page, select Member Reports.

Registration for provider online reporting

Note: Your organization's administrator must complete this registration process and grant users in the organization access.

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the health plan.
  3. From the Payer Spaces home page, select the Resources tab.
  4. From the Resources tab, select Provider Online Reporting. If you don’t see it in the list, select Next from the right-hand side at the bottom of the page.
  5. Select I Agree on the disclaimer page.

You’ll be redirected and see the message, "Welcome to provider online reporting."

  1. Select Register/Maintain Organization to register your organization’s tax ID to the applicable program.
  2. Select Register Tax ID to register for the eligible program (member reports or panel listings).
  3. Select Maintain User/Register User to grant access to users.
  4. Complete all fields on the Register User page. Select ADD TO PREVIEW and Save.
  5. Go to Report Search, select the program, complete the required fields and select Search.
  6. A file should now be available.

To access provider online reporting for all users once registration is completed:

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the health plan.
  3. From the Payer Spaces home page, select the Resources tab.
  4. From the Resources tab, select Provider Online Reporting.
  5. Select I Agree on the disclaimer page.
  6. Go to Report Search, select the program, complete the required fields and select Search.
  7. A file should now be available.

Patient360

To access Patient360:

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the health plan.
  3. From the Payer Spaces home page, select the Applications tab.
  4. Select the Patient360 tile.