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