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Are you getting the best claim status information?

 

8.15.2023 By Christina Love, Product Director

 

If not, ask your health plans about Enhanced Claim Status

Have you ever checked the status of a claim electronically—through a provider portal, an EHR or practice management system, or a billing system—and received a response that left you thinking, “Well, this isn’t very helpful.” You wanted to avoid calling the health plan, but the vague response left you no choice.   

 

When you receive complete claim status information, you’re less likely to have to call the health plan. That’s what Availity’s Enhanced Claim Status is designed to do. It’s an API transaction health plans can enable to enhance the standard electronic claim status response (X12 278/288) with richer, more contextual information. For providers, the information is automatically included in the response, so you don’t have to do anything different or look somewhere else. 

 

Better data in the claim status response

“It is much easier to use and saves time when checking on claims!”

 

With Enhanced Claim Status enabled, you can receive information like the patient’s group number and subscriber relationship, the date a check was cashed, specific diagnosis codes, and much more. Health plans have more than 300 data fields they can customize to make sure their providers are getting accurate and informative results. Many health plans are using Enhanced Claim Status to provide more specific denial codes, so providers can save time by knowing exactly what to correct before resubmitting the claim. 

 

Participating health plans

You can find out if your health plan offers Enhanced Claim Status by visiting the Availity Essentials Payer List and searching for your health plan. If Enhanced Claim Status is listed as “available,” that means you have access to this rich claim status information through Availity Essentials and Availity Essentials Pro. Many health plans are in the process of implementing Enhanced Claim Status, including commercial, Medicaid, and dental plans, so check back to see updates.

 

Ask your health plans to implement Enhanced Claim Status

If your health plans don’t yet offer Enhanced Claim Status, let them know you’re interested. Essentials users can use the Feedback button on the Claim Status application. If you manage claims through an EHR or practice management system, talk to your vendor about having more health plans participate.   

 

 

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