1
Pre-Visit & Scheduling |
Eligibility & Benefits (E&B) Inquiry |
- Ensure coverage is active
- Print a copy of eligibility and benefit results to place in patient’s file.
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- Provides access to Availity Transaction ID (fast path)
- Streamlines workflow
- Reduces telephone time
- Is the gateway to other electronic tools such as CareProfile and CareCalc
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| CareCalc |
- Check for coverage of specific procedures and determine estimated financial responsibility
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- Helps with collections
- Reduces account receivables
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| CareProfile |
- View and print two years of the patient’s medical claims history including lab results, hospitalization, prescription history and more
- Access and print a CareProfile for multiple scheduled patients in batch
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- Complements the physician’s own medical record
- Streamlines workflow with batch function for scheduled patient visits
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| Health Care Service Inquiry/Review (Authorization & Referral) |
- Review services to determine whether the definition of medical necessity is met for coverage and payment purposes only under the member’s contract
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- Prevents possible penalties for not obtaining approval
- Allows providers to receive approval within appropriate timeframes
- View provider authorizations online
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2
Check-in |
Eligibility & Benefits (E&B) Inquiry |
- Ensure patient’s coverage has not changed
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- Provides access to Availity Transaction ID (fast path)
- Saves time
- Is the gateway to other electronic tools such as CareProfile and CareCalc
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| CareRead/Care Collect |
- CareRead populates patient information into Availity transaction pages when patient’s card is swiped through a card reader
- CareCollect allows providers to swipe credit cards or PIN-less debit cards to easily process payments with minimal data entry. You can also manually enter card information or checking account information.
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- Reduces key strokes
- Schedules recurring payments
- Voids and credits payments
- Performs end-of-day settlements
- Runs reports of payments processed
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| CareCalc |
- Determine a patient’s financial responsibility using procedure and diagnosis codes for a patient’s visit
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- Helps with collections at the point of care
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CareProfile |
- Provides an electronic or paper view of the patient’s treatment across providers based on two years of claims history
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- View a patient’s recent health care services (i.e., prescriptions, labs, radiology, immunizations, hospitalizations and more)
- Gives health services information about new patients
- Complements the physician’s own medical records
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3
Exam |
CareProfile |
- Provides an electronic or paper view of the patient’s treatment across providers based on two years of claims history
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- Helps identifies treatment gaps
- Reduces unnecessary procedures
- Identifies overuse, under-use or misuse of treatments
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| Electronic Prescribing |
- Allows the prescriber to check formularies, see drug-to-drug alerts, see allergy alerts and submit prescriptions to the pharmacy electronically.
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- Streamlines workflow
- Reduces callbacks from pharmacies
- Reduces prescription errors
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| Health Care Service Inquiry/Review (Authorization & Referral) |
- Review services to determine whether the definition of medical necessity is met for coverage and payment purposes only under the member’s contract.
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- Prevents possible penalties for not obtaining approval
- Allows providers to receive approval within appropriate timeframes
- View provider authorizations online
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| eMedicine |
- Conduct confidential e-Office visits
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- Offers patients a safe and confidential way to communicate about non-urgent health care needs
- As easy to use as email and incorporates security measures that help ensure the patient’s privacy
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4
Patient Check-out |
CareCalc |
- Determines patient’s estimated financial responsibility using procedure and diagnosis codes the patient received
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- Helps with collections while the patient is still in the office
- Reduces telephone time
- Can be printed and shared with patients
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| Real Time Claim Adjudication |
- Submits a professional quick claim to BCBSF from CareCalc results; renders a response in less than two minutes
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- Faster claims processing and payment
- Streamlines claims management
- Eliminates administrative costs associated with billing, such as postage, paper handling, etc.
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| CareRead/Care Collect |
- Swipe a BCBSF member's ID card through a card reader and automatically populate Availity transaction pages with the information
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- Eliminates the need to manually key member information
- Collect patient financial responsibility
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5
Billing |
Electronic Claim Submission |
- Submit claims quickly and easily online; receive patient financial responsibility
- Can use claim submission through current billing system
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- Faster claims processing
- Quickly identifies claim submission errors
- Reduces administrative costs
- Environmentally friendly
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| Claim Reconciliation Tool (CRT) |
- View status of multiple claims submitted to certain payers in various ways (e.g., within a specific date range)
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- Obtain Availity Transaction ID (fast path)
- Manages account receivables
- Reduces telephone time and administrative costs
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6
Claims Follow-up & Payment and Claims Reconciliation |
Claim Reconciliation Tool (CRT) |
- View status of multiple claims submitted to certain payers in various ways (e.g., within a specific date range)
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- Provides access to Availity Transaction ID (fast path)
- Manages account receivables
- Reduces telephone time and administrative costs
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| Electronic Claims Submission |
- Safely and securely submit and track HIPAA-compliant electronic claims.
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- Allows claims to be paid more quickly
- Reduces administrative costs
- Eliminates errors due to illegible or inaccurate information
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| Electronic Funds Transfer |
- Receive claim payments safely and securely by direct deposit to a designated bank account at the financial institution of your choice.
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- Delivers payments days sooner than paper payments by mail
- Elimination of lost or stolen checks
- Increased administrative efficiencies and greater convenience
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| Electronic Remittance Advice (835) |
- Contains an explanation of claim payments, claim denials and other financial information necessary to reconcile patient accounts online
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- Delivers an ERA days sooner than a paper version
- HIPAA-AS compliant transaction
- Secure web-based tool is available 24 hours a day
- Can be printed via a practice management system or billing software
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| Remit Reader |
- View the electronic remittance advice (835) information and proprietary codes through Availity versus a paper remittance advice.
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- Provider no longer needs to use a large paper remittance to reconcile their claims payments
- Reduces the time to research remittances (manually versus electronically)
- Allows for payment information to be received much quicker than the postal service
- Sync up to the payment and payment information for faster paperless payment
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