What you need to know about Availity Essentials Plus

Availity recently launched Availity Essentials Plus, a new addition to our provider product suite which also features Availity Essentials (formerly the provider engagement portal) and Availity Essentials Pro (formerly RCM). Since the launch, we’ve had a lot of questions about the differences in the products, so I’m providing more details to explain.   

What is Availity Essentials Plus, and how is it different from Availity Essentials?

The Availity Essentials Plus subscription allows providers to submit transactions to additional health plans that are not available on the free Essentials platform. With Essentials, providers can check eligibility and submit claims for patients in a wide range of plans—from national ones to regional plans.

Why did Availity create Essentials Plus?

For a long time, we’ve received feedback from Availity providers who were looking for a browser-based solution to reach more health plans. Essentials didn’t have all the payers they needed, and Essentials Pro’s robust feature set was more sophisticated than many practices required. Without a “middle-tier” option, these providers didn’t have an easy, economical way to submit transactions. Essentials Plus addresses that market gap.   

Why is Availity charging for Essentials Plus when Essentials is free?

Essentials is an amazing platform with rich content that’s made possible through our relationship with many health plans. Because these health plans sponsor Essentials, we don’t have to charge providers for transactions from those plans. Essentials Plus extends access to non-sponsoring health plans, allowing providers to access more plans from the same platform.

Will the health plans available through Essentials Plus have their own forms or workflows?

No. That’s the beauty of a single source: it provides a consistent user experience. Everything will be the same as it is on Essentials in terms of how to complete a form. For example, how to research a patient’s eligibility, and how that information comes back to you stays the same across all health plans.

How do I know which health plans are available on Essentials and which are on Essentials Plus?

Visit Availity’s Payer List and type in the name of the health plan. If the Portal column says “Available,” the health plan is free on Essentials. If it says, “Get Essentials Plus,” it’s available in Essentials Plus.

The Payer List also shows you which transactions are available on Essentials Plus. Right now, there are approximately 70 additional health plans available for eligibility and 50 for claim status, and we are adding more each day.

How much is an Essentials Plus subscription?

We have one Essentials Plus plan, with early adopter pricing while we continue to build out our payer list. The subscription costs $25 a month and includes unlimited transactions with sponsored payers, plus 250 non-sponsored transactions. If you run more than 250 transactions with Essentials Plus plans, there’s a small overage charge for each transaction.

How do I get started with Essentials Plus?

First, you need to be a registered Availity user, so if you haven’t yet done that, now is a great time to register. Once you’re logged into Essentials, you can click on the “View Essentials Plans” under the Patient Registration and Claims and Payments menus. You can also go to “My Account,” click on Plans and Subscriptions, and select “View Essentials Plans.”

What else do I need to know?

We would love your feedback on other health plans you want to see available on Essentials Plus. You can give your feedback by logging on to Essentials and navigating to Help and Training > Availity Support. Once you are on the support page, open a Case with the Subject “Essentials Plus Payer Request” and select Premium Access as the Case Reason.  In the form, provide us with the desired transaction(s) and Payer name for our product team to review.