ACS Jeopardy

Log In/Registration

100

Can we complete a BUC request for a user admin

We can only complete BUC for an ADMIN with no other user admins on the account. 

200

Can you register an Org without being ID verified?

Yes, but org will not be completed until ID verification is completed. 

300

Can a user change their two step authentication method from the log in screen? 

Yes, but only with a BUC as they need to verify their 2 step first. 

400

If the customer has T-Mobile or Sprint as their carrier and is not receiving their passcodes...

This means they have enabled the blocking of toll-free numbers and short-codes. The customer will have to contact T-Mobile/Sprint by calling 611 (technical support) and asking to lift the block of short-codes. There is nothing Availity can do to resolve this as it is a T-Mobile/Sprint security feature.

500

If an application is pending DOCs what documents are needed for a sole proprietorship? 

An SS4 within the last two calendar years or a 147C letter within the last 90 days. 

portal questions

100

Where to find claim rejections that do not participate in CS tool if submitted through availity? 

via the received file folder

200

what is frequency type 8 used for on claims forms? 

Void/Cancel a Prior Claim

300

Is enrollment needed for EOB for the payer: Magellan Healthcare

No, they are an auto remittance sender, https://availity.lightning.force.com/lightning/r/Knowledge__kav/kaEHp0000008QEmMAM/view

400

Error: "Invalid/Missing Subscriber/Insured ID – Please Correct and Resubmit."

Solution:

• Verify the member information is entered correctly.
• If the payer is available on the portal, run E&B to verify coverage.
• If coverage is active for DOS and the information is entered correctly (Name, DOB, MID, etc.), open up a ticket with the payer. Be sure to include a screen shot of the results page.

500

If a Provider calls in to bring E&B discrepancies to our attention. An E&B discrepancy occurs when the provider runs E&B on the Availity portal and obtains information, but they receive conflicting information when they reach out to the payer by phone.

We create a payer review ticket needing: 

• Payer phone # the provider called
• Who they spoke with (the person’s name)
• The call reference # for the call

KNOWN ISSUES

100

Parent Case: 16008477 

Humana has reported that there was an issue with delivering some ERAs for check date 7/17. The Payer is working to resolve at this time.

200

Parent Case: 15995787 

Auth/Ref Regence "Take Me To Carelon" Linkout Error

300

Parent Case: 15996070 

Cigna Missing Claim Response - Team, we have been advised that Payer: Cigna, Payer ID: CIGNA has missing claim responses, which may appear as claims that are "In Progress" in ATS.

400

Parent Case: 15970090 

UCare Claim rejections for Payer ID: 52629 Team, we are aware that claims are rejecting for Invalid Payer ID for UCare claims under payer ID: 52629 are rejecting. We are working on resolving this issue.

500

Parent Case: 15963368 

Humana ERA/EFT Add or Cancel Requests Stuck in Process - Team, we have been made aware of an issue with the Humana ERA/EFT Maintenance tool causing some requests (Cancel or Add ERA/EFT) for the attached list of TINs to be stuck in process.

Common Errors

100

Error: "Rendering Provider: Required Application Data Missing - Please Correct and Resubmit."

Solution:

• Open a Payer Review ticket. If possible, add the X12 data for the payer to review.

200

Error: "Service Information: Required application data missing (requested data not returned) - Please Correct & Resubmit."

Solution:

• Open a Payer Review ticket. If possible, add the X12 data for the payer to review. 

300

Error: "You are not authorized to submit a referral for this member. Please contact the member's PCP."

Solution:

• If the payer is available on the portal, run E&B to verify the PCP.
• If the entered provider is the PCP, open a ticket with the payer. Please include a screenshot of the E&B showing the provider as the PCP with the Payer Review ticket.
• If the user is stating that they are the PCP, and the payer is not available on our portal for E&B, then we can open up a ticket with the payer.

400

Error: "Rendering Provider Specialty: Enter a valid Rendering Provider Specialty."

Solution:

• This error indicated the Taxonomy entered does not match what the payer has on file for this provider.
• If the user advises the Taxonomy entered is correct, then we can open up a ticket with the payer.

500

Error: "504 The health plan is down for maintenance."

Solution:

• Check the Known Issues List and Network Outage List.
• Complete browser troubleshooting
  • Clear cache & cookies
  • Have the user switch to another browser
• If troubleshooting does not work, please confirm with the user if they have been receiving this message for more or less than 2 hours.
  • If less than 2 hours, please ask them to try again later.
  • If more than 2 hours, obtain a screenshot and open a ticket with Analysts.

Security Protocols

100

How Many SQs can we ask? 

Two 

200

Can we use information from org without confirming with caller? 

When documenting information in Salesforce, ask the caller for each piece of information listed in the template which is related to the call scenario you are encountering. The Org Info screen could have outdated information, which can delay or lead to an inaccurate resolution.

300

Can we assist with generic named accounts 

NO, they will need to create a new account for individuals and call back in. 

400

what is the updated beginning call flow 

(1) Ask the caller for their First and Last name. (2) Ask the caller for their Availity User ID. (3) Use AV Search to pull up the User ID in question and compare the name the caller gave you. (4) Ask a Security Question. This is required on every call. (5) Ask for the Tax ID or Customer ID they are calling about. NPI CANNOT be used to verify an Organization. (6) Ask the caller to confirm the name of the organization. ACS may accept the DBA name as verification.

500

If someone needs interpretation of E&B or a Claim we... 

Do not interpret payer decisions,  you should always refer them to the payer.