Eligibility
Where you can see if a payer has an eligibility fee
What is OCS?
Action a client should take if they do not have a remit
What is log a missing remit ticket?
Claim status that means a payer needs to be mapped
What is Payer Match?
Places you can view enrollment paperwork
What are the application and OCS (using in IE)?
Challenges that patient statements help clients overcome
What are returned statement/undeliverable mail and printing, stuffing, and posting statement manually?
2 types of eligibility batches that can be submitted
What are a pipe delimited file and a 270 file?
Can be utilized to quickly view checks in RCM and ARIES as well as shows status of remits
What is the remit research tool?
Unknown claim status
Availity has not received a status back from the payer. A CSC rep should log a FORE ticket to follow up.
Most common claim rejection when enrollment has not been completed
Submitter not approved for electronic claim submissions on behalf of this entity: Billing Provider
Allows clients to submit an electronic claim file containing secondary claims which Availity then submits to our print vendors
What is Drop-to-Paper Secondary?
Client receives "Request Error: CMS Eligibility access requires a valid NPI provider number. The NPI number was not found and is not currently authorized to access CMS eligibility. Please open ticket requesting access to CMS eligibility" when running an eligibility request for Medicare. Clients needs to...
What is they need to complete Medicare Rules of Behavior?
Where to change what type of remit file a client receives
What is in OCS under Remittance Setup?
Action client must take if they receive an error containing " Procedure NOC/Unlisted field populated"
What is add a description to the affected procedure code on the line level of the claim?
Trading Partner ID
What is found in the enrollment paperwork?
Allows clients to send attachments to all payers
What is All Payer Attachments for Medical Claims
How to resolve "2100B: Provider Ineligible for Inquiries. Please Correct and Resubmit" error
What is they need to fill out eligibility enrollment paperwork?
2 ways clients can receive remits from Availity
What are FTP/SFE and via the application?
Reasons why a claim may fall into a Dead Claim status
What is the claimed failed to process due to the payer name or match value not being received
What a client should do if they receive approval from the payer on an enrollment
What is upload it to the CEET tool?
Provides EOB-to-ERA conversion for clients
What is MediStreams?
3 major pieces of info you should obtain when logging an RTE case
What are the 270/271 response files, the payer name and the time/date of the transaction
Submitting copy of the EOB for a missing remit
What is the payer needs more detail and/or the remit may have been processed through a different payer
Actions client should take regarding payer returned COVID claims
What is the client needs to obtain updates from the payer's website; review RCM Best Practices for COVID-19 (https://www.realmed.com/ref_files/COVID19/RCM_Best_Practices_COVID19.pdf)
A reason why uploading paperwork may fail
What is the filename is too long?
Clients can use this to generate the 276 claim status requests in real time or on a schedule allowing them to check status for any claim regardless of how it was submitted
What is Advanced Real-Time Claim Status (RTS)?