Highmark will be replacing its existing provider portal, NaviNet®, with Availity® Essentials. Availity serves plans nationwide, including many Blue Cross Blue Shield Association licensees like us. Availity’s multi-payer platform will support the existing payer-provider transactions necessary to manage care for Highmark members, including eligibility and benefits, claim status, and claim submission, and serve as a gateway to our utilization management platform to perform authorization transactions.
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Below is additional background information and frequently asked questions about the transition.
Overview
What is Availity?
Availity® is a company that operates a multi-payer provider portal, called Availity Essentials, with easy-to-use online tools for health care providers. Established in 2001, Availity connects over a million providers to health plans in the United States with tools for patient eligibility and benefits, claims status and authorization to facilitate the business side of health care.
Why is Highmark moving to Availity?
Keeping in mind provider feedback and the future vision of Highmark’s digital platforms, we evaluated the advantages of our current provider portal and areas where we can improve. We looked closely at our opportunities to offer an enhanced online experience and found that Availity meets many of the criteria that will help us better serve you.
Availity’s expertise is in building and managing a provider portal with tools that are easy and useful to health care providers. The company continually seeks provider feedback to improve its website for all users. Benefits include:
- A single login and password that lets you check eligibility and benefits or the status of a claim for patients with coverage from multiple health plans without logging into different systems.
- Customized tools within Availity for Highmark information that will better meet your needs.
- Express Entry that lets you set up specific providers in the system so you can click on them from a dropdown menu and have information automatically populate. This means you don’t have to retype data, such as NPI numbers or provider names.
- Access to Highmark-specific resources through a dedicated payer space.
Which Highmark plans will I be able to access in Availity?
- Highmark Blue Shield
- Highmark Blue Cross Blue Shield
- Highmark Blue Cross Blue Shield Delaware
- Highmark Blue Cross Blue Shield West Virginia
- Highmark Blue Cross Blue Shield of Western New York
- New York state plans already use Availity for its Medicaid and CHP lines of business. Now Commercial, FEP, ACA and Medicare Advantage plans will be added.
- Highmark Blue Shield of Northeastern New York
Highmark Wholecare and Highmark Health Options will not transition to Availity; providers should continue to use their current portals for transactions related to these plans.
When is Highmark moving to Availity?
The transition will be occurring in stages to ensure a seamless transition:
- August and September 2023: Highmark will engage a pilot group of providers. If your organization is chosen, you will receive an email from Highmark.
- October 22, 2023: Providers who currently use Availity for other payers will see Highmark as an option in the states in which they are contracted. Providers who are newly contracted with Highmark after October 22, 2023 may register for Availity.
- February 5, 2024: Availity will be available to all Highmark providers.
- March 2024: Providers will no longer have access to NaviNet or HEALTHeNET (NY).
- More information on the retiring of existing portals will be distributed as it becomes available. If you don’t already receive emails for our provider newsletters, join our eSubscribe list today.
Is there a charge to providers for using Availity to access Highmark information?
There is no cost to providers to access it.
Registration
What do providers need to do for this transition?
If your organization is already registered with Availity, you do not need to re-register. You may only need to review the Highmark-specific features once they are live.
If your organization is not already registered with Availity, you should register for access starting January 10, 2024, or soon thereafter. For details, go to the Register and Get Started with Availity Essentials webpage.
Our office already uses Availity. Do we need to do anything to be able to access Highmark information in Availity (to check eligibility, request authorizations, etc.)?
Highmark is available to you as a payer in the dropdown menu, listed as one of the following depending on which Highmark plans you are contracted:
- Highmark Blue Shield
- Highmark Blue Cross Blue Shield
- Highmark Blue Cross Blue Shield Delaware
- Highmark Blue Cross Blue Shield West Virginia
- Highmark Blue Cross Blue Shield of Western New York
- Highmark Blue Shield of Northeastern New York
If you have access to more than one state or region, be sure to first select the appropriate state from the dropdown menu located in the top navigational bar on the Availity Essentials home page. For example, selecting Pennsylvania will allow access to all available Pennsylvania payers, including Highmark Blue Shield and/or Highmark Blue Cross Blue Shield.
Will we sign in with the same username and password?
If you’re already registered with Availity, you will use the same Availity username and password you use today.
How soon should providers register for Availity?
Providers who are not currently registered to use Availity should register for access starting January 10, 2024, or soon thereafter. For details, go to the Register and Get Started with Availity Essentials webpage.
What is the Availity contact information for registering?
With Availity, an individual in your office or facility serves as the administrator. That individual can register with Availity online. The office administrator can begin the registration process on the Register and Get Started with Availity Essentials webpage. After registering an organization, the administrator can add other users from the administrator’s organization.
To learn more about registering and getting started with Availity, go to the Register and Get Started with Availity Essentials webpage.
If you need assistance with an existing account or have started the registration process and are experiencing issues, you can contact 1-800-AVAILITY (282-4548), Monday through Friday, 8 a.m. to 8 p.m. Eastern time.
What should providers who are not currently registered for Availity do now?
Providers who are not currently registered to use Availity should register on January 10, 2024, or soon thereafter. To register:
- Select someone in your organization (office, practice, or facility) to serve as the primary Availity administrator. This person will handle access to Availity for other users, speeding up the enrollment process. The primary Availity administrator will be able to add team members or change access with just a few keystrokes.
- The organization should also delegate some team members to assist the primary Availity administrator. These individuals can handle requests when the primary Availity administrator is not available.
- For the best experience and a smooth transition to Availity, review the technical requirements for optimum performance.
- You can find these requirements on the Availity website. Scroll down and click on the Requirements tab.
- Your Availity administrator should register at availity.com by clicking on Create an Essentials Account in the upper right corner of the screen. After registering the organization, the administrator can add other users and assign access roles.
Can there be one administrator for multiple providers who each bill under their own NPI and are not a group?
One person can be the administrator for multiple organizations, and that administrator still has only one user ID and password which is the same for all the organizations he or she manages. The administrator assigns users to the organizations. Each individual user has his/her own unique user ID and password, and each individual provider entity has its own profile.
How should large provider organizations handle selecting an Availity administrator? Can they have multiple administrators?
Large organizations can elect to register separate Availity accounts for distinct locations and/or departments or they can choose to have only one account. While organizations can have only one primary administrator for Availity, that administrator can assign the User Administration role to other users who can then assist with adding and editing users and user roles. View the Register and Get Started with Availity Essentials webpage for more information or call 1-800-AVAILITY (282-4548) for individual assistance.
We are a billing service. Will you enroll our provider information into Availity for us?
If you do not currently work with Availity, you will need to register with Availity as a billing service. Then, you’ll need to add your providers to your profile.
Will Availity administrators have to go into every existing individual user’s account to add Highmark access?
Current users automatically have access to Highmark information as we roll out access throughout the transition process (See fourth question for timeline). The only action an Availity administrator would need to take is when users have a different role within Availity for their Highmark work compared to their role within Availity for other payers.
Training
Will training be offered?
Availity will offer both live and on-demand training to providers. Training dates and information will be posted on the Provider Resource Center when available. We will also email your organization if you have signed up for our eSubscribe list. Click HERE to sign up.
The first three training sessions will occur on the following dates:
- Availity Essentials: Introduction to Highmark Providers (including Highmark’s Authorization Tool)
- Monday, October 23, noon
- Tuesday, October 31, 8 a.m.
- Claim Submission Applications for Highmark Providers
- Tuesday, October 24, 8 a.m.
- Thursday, November 2, noon
- Claim Follow-up and Payment Applications for Highmark Providers
- Friday, October 27, 8 a.m.
- Friday, November 3, noon
To attend, you must be registered with Availity. All registered providers will receive an email invitation for the training sessions.
Is the organization’s Availity administrator responsible for training the rest of the organization’s users?
All Availity users can participate in training. Additional information on training will be released when available.
Transactions
Will the functions I perform in NaviNet change when Highmark transitions to Availity?
Providers will be able to perform all the same tasks as they do today — eligibility and benefit searches, authorization submission and status checks, claims submissions and inquiries, view reporting, etc. The interface to perform some of these transactions may look different, but we will provide a crosswalk document that maps functions from their current locations in NaviNet to where they appear in Availity.
Availity will offer both live and on-demand training to providers to ensure your organization has opportunities to familiarize yourself with the new portal. Training dates and information will be posted on the Provider Resource Center as available.
- We will also email your organization if you have signed up for our eSubscribe list.
Authorization
Is the process for requesting prior authorization changing with the transition to Availity?
The process for requesting a prior authorization will not change although finding the tool to request the authorization is different. In Availity, providers will go to “Payer Spaces” and click the “Predictal” tile to enter an authorization and/or check status of a previous submitted authorization.
Can authorization requests for physical medicine services — managed by WholeHealth Living, a Tivity Health company — be submitted through Availity?
No, not at the present time. For physical medicine services managed by WholeHealth Living, providers in Delaware, Pennsylvania, and West Virginia should continue submitting these types of authorization requests through NaviNet.
For medication authorization requests, can I connect directly to CoverMyMeds through Availity?
Yes, there’s a link to CoverMyMeds under "Applications" in Payer Spaces. Once at the CoverMyMeds site, you can log in with your current user credentials.
If a prior authorization already exists for a patient, will the prior authorization transfer over to Availity or does a new prior authorization need to be submitted?
All previously submitted prior authorization requests will be in the Predictal Auth Automation Hub. Do not resubmit a request during the transition to Availity.
Eligibility and Benefits
I currently submit batch eligibility and benefit searches through HEALTHeNET. Will Availity have this capability?
You will have the ability to submit batch eligibility and benefit searches through Availity. Additional information on this process will be released when available.
Will member insurance card information be available in Availity?
Yes. To view member information in Availity, go to "Patient Registration" and then click "Eligibility and Benefits Inquiry."
Secure Messaging – Claim Investigations
Will responses to completed claim investigations initiated via NaviNet be available to view in Availity? Does that information get transferred, or will it be lost?
Those responses can only be viewed in the system where the investigation was initiated. NaviNet will continue to be available to view completed investigations until March 2024.
That information will not be lost. It will be retained in the system where it initiated.
If a claim investigation was submitted via NaviNet, will the response be viewable in NaviNet, Availity, or both?
No, the response can only be viewed in the system where the investigation was initiated. NaviNet will continue to be available to view investigations until March 2024.
If you are currently Availity-enabled for other payers, we encourage you to begin using Availity for Highmark members on October 22, 2023. This is the date that current Availity users can access Highmark on the Availity system. The sooner you can transition to Availity, the sooner your member transactions will move to one provider portal, Availity Essentials.
Will responses to Claim Status Investigations be available to all staff?
Yes, the responses can be viewed by all staff in the organization. However, only the original submitter can reply to Highmark … unless the organization’s administrator reassigns the claim to another staff member.
If users have access to Highmark in NaviNet, will their information automatically be transferred to Availity?
No, NaviNet and Availity are two separate systems. Registration information will not transfer from one system to the other. However, if users are currently registered in Availity, they will continue using their current profile to access Highmark. Current Availity users will see Highmark as a payer option for the Highmark plans they are contracted with beginning on October 22, 2023.
Will we still have access to remittances (Explanation of Benefits) going back six months?
Yes, Explanation of Benefits (EOBs) will be available on Availity for six months.
Reporting
I currently access Risk Manager through HEALTHeNET, will it be available in Availity?
While Availity Essentials is a multi-payer tool, Highmark will have a proprietary, plan-specific area called “Payer Spaces” to share our unique information and tools. A link to Risk Manager will be available there. Providers will need to sign up for a separate account to access Risk Manager information.
Additional information on this process will be released when available.
Will the process for accessing Helion scorecards and/or reports change when we move to Availity?
There will be no changes to the process with the transition to Availity. Users will continue to log into Helion Arc directly with their unique username and password to access Helion scorecards and reports and/or palliative, behavioral health, gap closure triggers.