DATED: January 21st, 2014
If you have received rejections with a rejection message statement that Availity Advanced Clearinghouse is required, here is what is going on.
Availity (traditionally a free clearinghouse) is changing their business model and pricing model. They are going towards a paid model with a monthly subscription (at the low end of 70.00 per month per provider) along with per claim fees. At this time, Availity is enforcing this on mostly government payers and some Blue Cross Blue Shield states. They are requiring that submitting to these payers through them, you must sign up for their Advanced Clearinghouse (which comes at the additional charge). Fortunately, Availity is only one of the clearinghouses that Therabill submits claims through.
To keep your costs down and maintain our current Therabill pricing structure, Therabill will be re-routing the payers that Availity is charging for through a different clearinghouse. Luckily, Therabill does not submit most of our government payers through Availity. However, there are a handful that we do and these are the ones that we will have to switch over.
EDI Pre-enrollment - Please read
Unfortunately, most government payers require EDI Pre-enrollment. Therefore, switching clearinghouses may require that you re-do any EDI Pre-enrollments for those payers. We have listed the payers at the bottom of this article that Therabill will be switching over within the next few days. Those that require EDI Pre-enrollment will have a link to the instructions for EDI Pre-enrolllment for the new clearinghouse (Office Ally).
NOTE: To minimize the amount of time it takes for you to begin submitting to the government payers listed at the bottom of this article, you may want to begin your EDI Pre-enrollments now (see "Payers that require EDI Pre-enrollment").
We know this is an inconvenience
Unfortunately, Availity's change is affecting a lot of people. We know first hand the amount of work this is putting on Therabill, but most of all, we know that this puts an inconvenience on you as a clinic. We can only hope for your understanding that this is out of our control. We are taking every step possible to continue offering an affordable product with no clearinghouse fee's or per claim fee's. Availity is no longer fitting into that mission, and therefore, we will need to phase out of our relationship with Availity.
Therabill's plan of action
Step 1: Therabill is in the process of identifying all payers that are considered to be in Availity's Advanced Clearinghouse.
Step 2: Therabill will prioritize re-routing of these payers. Those payers that require EDI Pre-enrollment will be identified first and switched over first. At this point, all payers that are now considered part of Availity's Advanced Clearinghouse (that they are charging a fee on) will be switched over.
Step 3: Therabill will send an e-mail to all Therabill members that may be affected by EDI Pre-enrollment (note, those payers that do not require EDI Pre-enrollment we can move over easily and without any hassle). We will supply links to the EDI Pre-enrollment forms for payers that are in your insurance list.
Step 4: Therabill will eventually be ending our relationship with Availity. Therabill will continue to go through our payer list looking for all payers that are currently routed through Availity and switch them over to alternate clearinghouses.
Timeframe: Steps 1 - 3 are high priority projects and we are expecting to be finished by 1/23/2014. Step 4 is a longer term project.
What you need to do
First, determine if one of your insurance companies is listed below. If they are, then they are affected by this change and require EDI pre-enrollment. You will want to prepare by following the EDI pre-enrollment instructions linked to with the payer. IMPORTANT: Once you have heard back from the payer that they have processed your EDI pre-enrollment, you must contact firstname.lastname@example.org to let us know. We will then call the clearinghouse on your behalf to let them know.
What if I have a payer that I know goes through Availity and is not listed below?
If you are submitting to an insurance company that you know Therabill sends through Availity then one of the following may apply.
- The payer does not require EDI Pre-enrollment. For payers that do not require EDI Pre-enrollment, this switch will be pretty painless and there will be no action required by you.
- Therabill is still in the process of putting together this list. Check back at this article over the next couple of days.
Payers that require EDI Pre-enrollment
- Medicaid Washington: http://officeally.com/files/Medicaid_WA_Pre-enrollment_Instructions_12262013.pdf
- Medicaid Illinois: http://officeally.com/files/Medicaid_Illinois_Pre_Enrollment_Instructions_01212011.pdf
- Medicaid Florida: http://officeally.com/files/Medicaid_FL_EDI_Enrollment_Packet_12242013.pdf
- Medicaid Alaska: http://officeally.com/files/Payer%20Enrollment%20Forms/Payer%20Enrollment%20Forms%20for%20State%20Specific%20Payers/Medicaid%20Alaska%20(AK)%20Enrollment%20Pkt%20WS%20082009.pdf
- Medicare A Florida: http://www.officeally.com/files/Medicare_FL_PartA_Instructions_07232014.pdf
- Medicare B Florida: http://officeally.com/files/Medicare_FL_Instructions_01012014.pdf
- Medicare B Alaska: http://officeally.com/files/Medicare_Alaska_Pre_Enrollment_Instructions_11122013.pdf
- Medicare Oregon: http://officeally.com/files/Medicare_Oregon_Pre-Enrollment_Instructions_11132013.pdf
- Medicare Washington: http://officeally.com/files/Medicare_Washington_Pre-Enrollment_Instructions_PartA_PartB_11132013.pdf
- Medicare DMERC Region C: http://officeally.com/files/DMERC_RegionC_PreEnrollment_Instructions_11062013.pdf
Blue Cross Blue Shield
- Washington (Premera) Blue Cross Blue Shield: http://officeally.com/files/Premera_Lifewise_EDI_20140103.pdf
- Blue Cross Blue Shield of Louisiana: http://officeally.com/files/Payer%20Enrollment%20Forms/Payer%20Enrollment%20Forms%20for%20State%20Specific%20Payers/BCBS%20LA%20EDI%20Enrollment%20Pkt%20WS%20120409.pdf