Introducing Availity Editing Services

Date: 11/21/24

In a continuous effort to make it easier to do business with us, Ambetter from Arkansas Health & Wellness is introducing Availity Editing Services (AES). Starting January 24, 2025, we are partnering with Availity to return rejection messages on our behalf via AES messages. These messages will show in your existing workflows. AES will give you an option, but not a requirement, to edit a claim.

Features

AES can identify a claim error upfront and alert you to correct it before it’s sent to the health plan for adjudication. You can review messages for potential corrections to the suggested claim line(s). By identifying possible errors upfront, AES can help claims process correctly the first time, preventing errors, improving payment accuracy, and improving claims adjudication turnaround time.

What This Means for You

This is not intended as a new method to deny a claim, nor does it bypass or replace downstream edits. You should review suggested edits for accuracy. If, after reviewing a claim error alert, you find it does not apply, please resubmit the claim as is. This will allow a bypass of the edit in cases where it may not be applicable.

If you choose to bypass an edit, it is possible that other downstream edits will still function as normal in our claims systems. Remember to submit your claim regardless of your choice to edit or bypass. This action is required in order for the claim to be processed in our systems.

If you have a Practice Management System (PMS), you can locate your edits report within your claims workbasket or queue reporting. If you submit claims via the Availity portal, any of these rejections will show on your normal reports.

Available Trainings

If you submit claims via Availity, learn how to gather your reporting by joining one of Availity’s free webinars to learn additional tips for streamlining your workflow:

• Send and Receive EDI Files — Training Demo
  • Learn where and how to access reports in Availity Essentials.
• EDI Reporting Preferences — Training Demo
  • Learn how to set up your EDI Reporting Preferences. This should be done by your Availity Administrator to access the reports in the Send and Receive EDI Files application.

Additional Assistance

If you need assistance with registering for Availity Essentials, 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 Provider Relations Representative.