Table of Content
The Availity provider portal gives you the information, tools and resources you need to support the day-to-day needs of your patients and office. Our electronic data interchange clearinghouse and API products allow providers to integrate HIPAA transactions and other features into their PMS, HIS, or EHR system or sophisticated custom applications. If the claim is denied or final, there will be an option to dispute the claim.
The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. The Applied Behavior Analysis Medical Necessity Guide helps determine appropriate levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The ABA Medical Necessity Guide does not constitute medical advice.
Enhanced Claim Status Responses (PDF)
The information you will be accessing is provided by another organization or vendor. Built on a powerful, intelligent platform, we put data to work through business solutions that strengthen communications, improve financial performance, and simplify processes and systems.
Treating providers are solely responsible for dental advice and treatment of members. Members should discuss any Dental Clinical Policy Bulletin related to their coverage or condition with their treating provider. Many of the tools you need — such as eligibility and benefits inquiry, claims submission, claims status inquiry, and authorizations — can now be accessed bylogging into the Availity Portal.
Working with Aetna educational webinars
Have instant access to all submission records from any location at any time of day. Availity will not work because you are using a browser in compatibility view. Turn off compatibility view now to access the Availity Web Portal. If your practice is new to Availity, you can use the registration link below to set up your account.
Note that you will need your organization’s tax ID to complete registration. Create and submit authorization requests quickly by attaching clinical documents for review. Submit secure online authorizations or check the status of existing ones with our Interactive Care Reviewer .
It’s easy to work with us on Availity®
ThroughMagellan’s Payer SpaceinAvaility Essentials, you can access Magellan-specific applications and resources via a single sign-on to Magellan’s provider website. View a crosswalk of how claims data was previously accessed on the Magellan site vs. how to access now on Availity Essentials. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. Like our proprietary messages from our Explanations of Benefits .
Just run a Claim Status Inquiry transaction on Availity® to see the enhancements. Availity remains your trusted source of payer information, so you can focus on patient care. Go to Report Search, select the program, complete the required fields and selectSearch.
Check eligibility and benefits
Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. All services deemed "never effective" are excluded from coverage. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. Visit the secure website, available through , for more information. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search." This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose.
The American Medical Association does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. With Availity Essentials, a free, health-plan-sponsored solution, providers can enjoy real-time information exchange with many of the payers they work with every day.
If there is a discrepancy between a Clinical Policy Bulletin and a member's plan of benefits, the benefits plan will govern. Aetna Clinical Policy Bulletins are developed to assist in administering plan benefits and do not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any Clinical Policy Bulletin related to their coverage or condition with their treating provider. Aetna Dental Clinical Policy Bulletins are developed to assist in administering plan benefits and do not constitute dental advice.
Continue to watch your inbox and our website as we introduce new online benefits and phase out functionalities on MagellanProvider.com. Get a thorough snapshot of your patient’s health and treatment history that now includes gaps in care and care reminders with Patient360. Attach medical records and documents electronically when needed to support a pending or denied claim.
