Q3 2024 Provider Newsletter

Date: 08/28/24

National Immunization Awareness Month

Why it matters:

Many patients are looking for reassurance from their provider that vaccines are safe and effective. A strong, clear recommendation is usually enough, but others may need more information. Listening to their concerns and answering their questions can help them feel confident in choosing to get a vaccine.

Practical strategies for successful conversations

Here are some strategies you can use during NIAM to remind your patients and parents to stay up to date on routine vaccinations:

• Talk to your patients and parents about any missed vaccines and assess vaccination status at every visit.
• Use plain language when addressing concerns about vaccine safety.
• Practice the share approach to help patients make informed decisions about vaccination.

Community Collaborations

Ambetter of Alabama sponsored 20 kids from the Boys and Girls Club of North Alabama to attend the local Huntsville Double A baseball game (Rocket City Trash Pandas -Rocket City Trash Pandas | MiLB.com

Upcoming Events 

Ambetter AL Community Health Fair on 9/21/24 in Mobile, AL 

Annual Conference & Expo (AL Primary Health Care Association) on 10/29-10/31 in Gulf Shores, AL

Provider Resources 

Have you had recent changes to your practice such as new providers, new locations, or similar? We are glad to help you with making those changes effective to prevent delays in processing claims. This will also ensure your practice displays correctly in our directory. Our Provider Network Operations team supports our providers by assisting with the following:

• Demographic Updates and Changes
• Adding Providers to existing Groups or Practices
• Provider Termination Requests

Please submit updates within 30 days of data change becoming effective to our Provider Network Operations team by emailing your request to the email address below. You can also use our roster form if you have a large number of updates. 

Member Advisory Group Meeting

Ambetter of Alabama is hosting a virtual Member Advisory Group meeting for our members on September 17th. At this meeting, we will educate members on how to get the most out of their health plan benefits and discuss the latest news about our programs and services.

We invite members to share their experiences and ideas with us. We look forward to hearing from our members!

Regulatory Updates

This is an FYI that the Alabama State Legislature passed amendments to the Alabama Insurance Code with HB 139 & SB 65 – Extends Statute of Limitations for Insurance Fraud Prosecution, signed into law on 5/16/24 and 5/17/24 respectively, and both are effective 10/1/24. Although this may not directly impact health insurer operations, we wanted you to be aware of this legislation. This law amends the Alabama Insurance Code to extend the statute of limitations timeframe for fraud prosecution from two years to seven years after alleged violations have taken place. Any information will be forwarded to the Alabama Law Enforcement Agency.

Availity Essentials 

As a part of our commitment to make it easy to work with us, Ambetter of Alabama has chosen Availity Essentials as its new, secure provider portal starting October 21st. 

If you are already working in Availity Essentials, you can log in to your existing Availity Essentials account to enjoy these benefits for Ambetter of Alabama’s members:   

• Use Availity Essentials to verify member eligibility and benefits, submit claims, check claim status, submit authorizations, and more.
• Look for additional functionality in Ambetter of Alabama’s payer space on Availity Essentials and use the heart icon to add apps to My Favorites in the top navigation bar. 
• Access Manage My Organization – Providers to save provider information. You can then auto-populate that information repeatedly to eliminate repetitive data entry and reduce errors. 

If you are new to Availity Essentials, getting your Availity Essentials account is the first step toward working with Ambetter of Alabama on Availity.  

Our current secure portal at ambetterofalabama.com is available for other functions you may use today.

Getting started: Designate an Availity administrator for your provider organization

Your provider organization’s designated Availity administrator is the person responsible for registering your organization in Essentials and managing user accounts. This person should have legal authority to sign agreements for your organization.

We're excited to welcome you to Availity Essentials, helping you transform the way you impact patient care with Ambetter of Alabama. If you need additional assistance with your registration, please call Availity Client Services at 1-800-AVAILITY (282-4548). Assistance is available Monday through Friday, 8 a.m. – 8 p.m. ET. For general questions, please reach out to your Ambetter of Alabama Provider Relations Representative.

Appointment Availability & Wait Times

Ambetter follows the accessibility and appointment wait time requirements set forth by applicable regulatory and accrediting agencies. Ambetter monitors participating provider compliance with these standards at least annually and will use the results of appointment standards monitoring to ensure adequate appointment availability and access to care and to reduce inappropriate emergency room utilization. View below the appointment availability for members:

• PCP - Routine Visits - 30 calendar days 
• PCP - Adult Sick Visit - 48 hours
• PCP - Pediatric Sick Visit - 24 hours
• Behavioral Health - Non-life Threating Emergency - 6 hours
• Specialist - Within 30 calendar days
• Urgent Care Providers - 24 hours
• Behavioral Health Urgent Care - 48 hours
• After Hours Care - Office number answered 24 hours/7 days a week by answering service or instruction on how to reach a physician. 
  

2024 Provider Satisfaction Survey launching in September!

Thank you for being a valued partner in our provider network!

In the coming weeks you may be among a select group of providers to receive a survey from us that will allow you and your staff the opportunity to provide honest feedback regarding your experience with us. Sharing your experience in this brief survey is how you can help us gain valuable insights to enhance and improve provider tools, resources, and operations to better support you.

We look forward to receiving your valuable feedback. Thank you!

• Please utilize all features & functions found in our Ambetter of AL website.
• Remember to contact your Provider Engagement Administrator with any demographic updates.
• Providers can create an account or login to our portal.