Availity BCBSND
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New BCBSND Provider Portal Offers Enhanced User Experience

Blue Cross Blue Shield of North Dakota (BCBSND) has partnered with Availity to offer a full suite of electronic data interchange (EDI) health information exchange services through a single online connection.

Availity offers secure online access to multiple payers and the ability to check eligibility and benefits, manage claims and remittances, request authorizations and referrals, and complete other secure administrative tasks online.

In the coming months, we will share more information about the Availity platform and how to use it. As changes emerge, you will see Availity and BCBSND leading efforts on education, provider engagement, and training. Check this page and www.BCBSND.com/changes for updates.

One login for multiple payers

Availity is a multi-payer site where you can use a single user ID and password to work with BCBSND and other participating payers online. Availity is compliant with all HIPAA regulations, and there is no cost for providers to register or use any of the online tools.

Tip: Before you start, make sure you have the following information handy:

  • Basic information about your practice, including your federal tax ID and NPI.
  • The name of someone with the legal authority to sign agreements for your organization. Typically, this is an owner or senior partner.
  • The name of the administrator in your office who will need to grant and maintain access to Availity for your entire organization.

For guidance or tips, view or print this quick guide or watch this demo.

  1. Go to www.Availity.com, click Register, and complete your Availity registration.
    • Who do I contact if I need help registering for Availity?
      For registration assistance, call Availity Client Services at 1-800-AVAILITY (282-4548) Monday through Friday from 8 a.m. to 7:30 p.m. Eastern time (excluding holidays).
      After you complete your registration, Availity will send you emails that include your next steps and temporary password. You may then begin adding other users for your organization.
    • Tip: After you complete your registration, we recommend that as the Availity Administrator, you review the Add User help topic on the Availity Portal to learn how to add users (in your office) to the organization you registered. The help topic explains how you can do this either one at a time or uploading a spreadsheet. To find this topic in the Availity Portal, click Help & Training > Find Help > Administrator > Add User.
  2. Start submitting claims.
    After you register your organization and add users, log in to Availity and then submit using one of the following three options:

If you're a...

1

If you need to submit via direct data entry...

2

If you need to upload your claims via the portal...

3

If you need to send and receive batch submissions using transport method FTP...

4

If you send receive EDI transactions through a Clearinghouse…

Provider who submits to BCBSND, AND is already registered with Availity, log in to Availity. Based on the type of submitter you are, you can then submit claims using one of the following three options

Click Claims & Payments

Select either Professional Claim or Facility Claim.

Click Claims & Payments | Send and Receive EDI Files.

For more information or assistance, refer to the “Manage EDI Preferences” steps in this quick guide.

Go to Help & Training > My Support Tickets > Open A Ticket and submit your ticket.

Availity will send you a response that includes your mailbox information.

If you need more information or assistance, refer to the “Accessing key resources” in this quick guide.

 N/A

Provider who submits to BCBSND, BUT is new to Availity

Click Claims & Payments

Select either Professional Claim or Facility Claim.

Click Claims & Payments | EDI Reporting Preferences.

For more information or assistance, refer to the "Manage EDI Preferences" steps in this quick guide.

Complete the Availity registration process. Please note that in step 2, you will need to select ‘Yes’ when asked about SFTP access. Upon completion of the Availity registration process, you will be prompted with Next Steps.

Availity will work with directly with your Clearinghouse to manage the transition. Unless your Clearinghouse contacts you, there are no steps for you to take at this time.

Note: You can still sign up and use the Availity Portal tools as needed.

Tip: For easier onboarding, we recommend taking advantage of the training options outlined in the Training and Resources section below.

        3.  Enroll and receive electronic remittance advice (ERA).
             After you complete your registration, refer to the Enroll for 835 ERA Delivery
             steps in this quick guide. If you wish to view your Remittance Advice in the
             Availity Provider Portal, your organization must be enrolled for 835 ERA Delivery.

        4.  Integrate your technology to get eligibility and claims statuses.
             Select from one of the following options:
  • Log in to Availity, click Help & Training and open a support ticket requesting a B2B setup.
  • Contact Availity Client Services at 1-800-AVAILITY (282-4548) and request a B2B setup. Assistance is available Monday through Friday from 8 a.m. to 7:30 p.m. Eastern time (excluding holidays).
  • Availity offers a variety of training and informational sessions through the Availity Learning Center (ALC). After you register with Availity, log in to the Availity Provider Portal and select Help & Training | Get Trained to access recorded demonstrations. Once there, search for “onboarding” to access quick and easy-to-follow demos to help you get started.
  • Refer to our “Clearinghouse Customer Quick Start Guide ” for easy set-up and access to demos and other EDI training resources.
  • The ALC also offers in-depth product training and continuing education via national industry experts.

For a period of time, certain functionality will be available in THOR and not in the Availity Portal. As additional functionality is enabled within Availity, this grid will be updated to reflect where you will go to use these tools or functions. We appreciate your patience as these functions are transitioned from THOR to Availity, with the goal of having core functionality transitioned to the Availity Portal by September 1, 2018.

Function

Portal

Transition to Availity *

Eligibility and Benefits Inquiry

Availity



Claim Adjustment

THOR

TBD

Claim Status Inquiry

Availity  
Register/View Electronic Remittance Advice (835)

Availity  
Authorizations/Referrals

THOR July 1, 2018
Professional and Institutional Claim Direct Data Entry

Availity  
Out of State Preauthorization

THOR

September 1, 2018

* Dates are subject to change
 
You can use the Crosswalk from THOR to Availity Portal help topic in the Availity Portal to learn where to find the tools you need on Availity or THOR, and which roles are needed to view these functions. To view or print the most current help topic:
  1. Log in to Availity.
  2. Click Help & Training > Find Help > Payer Tools > BCBSND > Crosswalk from THOR to Availity Portal.

Q: Why did I receive a request from BCBSND to register for Availity?
A: BCBSND is migrating many of their current services from the THOR Provider Portal and Electronic Data Interchange Support Services (EDISS) to Availity’s Portal and Intelligent Gateway (EDI services). Provider applications in THOR will be disabled as they are no longer needed, with the goal of completing migration by June 15, 2018.

Q: Why does BCBSND want me to use Availity?
A: BCBSND has partnered with Availity as part of their overall efforts to better serve members, employer groups, providers, and other key stakeholders. Availity Intelligent Gateway facilitates billions of health care transactions and has capabilities to automatically identify anomalies between provider submissions and payer records, creating greater transparency and efficiencies for providers and payers alike. Users can access information and transactions from BCBSND and other payers on one website, using a single user ID and password.

Q: Is the THOR Provider Portal being discontinued?
A: Yes, BCBSND will be migrating providers to the Availity platform with the goal of completing migration by June 15, 2018. Provider applications in THOR will be disabled as they are no longer needed. BCBSND will share more information about the process as it becomes available.

Q: What tools and features does Availity offer?
A: With Availity, you can use a single user ID and password to access BCBSND and other participating payers online 24/7 from any computer with internet access. Availity is compliant with all HIPAA regulations, and there is no cost for providers to register or use any of its online tools.

Q: What do I need to know about my claims (837)?
A: The BCBSND transition to Availity includes moving THOR functionality to the Availity Provider Portal and changing our EDI services.

If you submit claims to BCBSND today through a clearinghouse, your transaction volume will be transitioned when your clearinghouse transitions BCBSND volume to Availity, so thereis likely no action required on your part.

We encourage you to reach out to your clearinghouse proactively to confirm there are no activities that require your involvement, and to confirm their anticipated transition date.

If you submit claims directly to BCBSND today through Electronic Data Interchange Support Services (EDISS) or THOR Real Time Claims, you will have 3 options moving forward:

A. SFTP—Develop a direct integration via SFTP (secure file transfer protocol) with Availity to submit BCBSND medical claims. To do this, call Availity Client Services at 1-800-AVAILITY to open a ticket requesting to submit your EDI.

You or your vendor may need to make changes to your software system (e.g. practice management system or EMR) to build and transmit your BCBSND medical claim files to Availity. We recommend you contact your vendor to ensure they are aware of the transition and can accommodate any necessary changes.

B. Web Upload—If you have a software application, such as a practice management system or EMR, that builds claim files and then transmits them to EDISS, you can use these same systems to build your claim files for Availity.

With the transition to Availity, you’ll need to upload your BCBSND medical claims using the Availity Provider Portal instead of submitting to EDISS directly. To do this:

  1. Log in to Availity.
  2. Click Claims & Payments in the top navigation bar.
  3. Under the Manage File Transfer section, select Send and Receive EDI Files.
  4. Click Send Files and then Choose Files to upload your claims.

Important:

  • The Availity Portal is for BCBSND medical claims volume only. You will continue to submit claims for payers other than BCBSND directly to EDISS. Examples of the types of claims EDISS will continue to support are:
    • Medicare
    • Medicaid
    • Workface Safety and Insurance (WSI)
    • BCBSND Dental (non-UCD)
    • BCBSND Vision (non-VSP)
  • For BCBSND, dial-up submission will no longer be supported; however, the Availity Web upload feature will provide an enhanced workflow for transmitting medical claims to BCBSND.
  • If you use PC-ACE to build BCBSND medical claims and wish to continue to Web upload your BCBSND medical claim files (instead of using Availity’s claims Direct Data Entry), you’ll need to have an alternate solution in place by June 18, 2018. On this date, BCBSND will discontinue support of PC-ACE for BCBSND medical claims only. You will instead have the following options:
    • Contract directly with ABILITY, the vendor for PC-ACE software, to continue using the PC-ACE software for BCBSND medical claims. For more information about ABILITY, please visit their website at https://abilitynetwork.com.
    • Contract with another third-party software vendor or clearinghouse.
      Note: The decision to contract directly with a third-party vendor (e.g., ABILITY) may incur additional costs. You will need to discuss your contract terms and cost with the vendor you choose.

C. Direct Data Entry (DDE)—If you submit professional medical claims to BCBSND today using the THOR Real Time Claims application, you will now use the Availity Portal DDE tool to submit BCBSND professional and institutional/facility medical claims. To do this:

  1. Log in to Availity.
  2. Click Claims & Payments, Professional Claims or Facility Claims and then complete and submit the request.

Finally, if you decide to submit BCBSND transactions using any of the methods noted above (SFTP, Web Upload, or DDE), we encourage you to log in to the Availity Portal to review your claim reporting preferences and update as needed. To do this, click Claims & Payments | EDI Reporting Preferences.

Q: What do I need to know about my electronic remittances (ERAs)/835?
A: BCBSND is no longer offering paper remittance advices, but with the transition to Availity we now offer the following options:

A. Receive 835 ERA delivery on the Availity Portal, to be processed by your practice management system or EMR via EDI.
    Note:
If you currently receive ERAs through a clearinghouse, the transition of your ERAs will be completed by your clearinghouse and no action should be required on your part.
    We encourage you to reach out to your clearinghouse proactively to ensure they are accounting for the transition of your ERA volume.

B. View your remittances using the Remittance Viewer in the Availity Portal.

Both options require you to enroll for ERAs with Availity. If you’re not already enrolled in 835 ERA delivery, refer to this quick guide for tips.

Important!

If you were previously enrolled for ERAs with BCBSND, you’ll have access to 6 months of historical remittance advice using Availity’s Remittance Viewer.

If you were not previously enrolled for ERAs with BCBNSD, you will not have access to historic remittances within the Availity Portal. Your remittances will be available beginning the date you enrolled to receive ERAs through Availity.

As of June 18, 2018, all organization not already enrolled for ERAs on the Availity Portal will be auto-enrolled, and you will be able to access your remits using the Remittance Viewer in the Availity Portal.

To have access to Remittance Viewer in Availity, you need to be assigned the correct Availity role. To ensure you have correct role and access set up, please reach out to the designated Availity administrator at your organization.

For questions about:

Contact the following:

Availity Provider Portal or Availity Intelligent Gateway transactions

1-800-AVAILITY (282-4548) Monday through Friday
8:00 a.m to 7:30 p.m. Eastern Time
or
7:00 a.m. to 6:30 p.m. Central Time

 Availity capabilities for BCBSND
1-800-AVAILITY (282-4548) Monday through Friday
8 a.m. to 7:30 p.m. Eastern Time
or
7 a.m. to 6:30 p.m. Central Time
 THOR capabilities for BCBSND
 Call THOR Support at 800-544-THOR (8467) or email thor.support@thor.org
 BCBSND’s transition  Email BCBSND at prov.partners@bcbsnd.com
 Benefits, eligibility, claim status, or payment  Contact BCBSND Provider Service at 800-368-2312.

Availity LLC is an independent company providing health information networking services for Blue Cross Blue Shield of North Dakota.