Upcoming Enhancements
|
Details
|
Targeted Resolution
|
Release Date
|
Status
|
Quick Claims |
Allows providers to create templates that pre-populate certain fields when submitting a CMS-1500 claim. |
Providers will have access to Quick Claims for Highmark members. |
April 20, 2024 |
OPEN |
|
|
|
|
|
Known Issues
|
Details |
Targeted Resolution |
Release Date |
Status |
Claim Status |
The following fields are missing/incomplete on the response screen:
- Payee information
- Member UMI displaying as "XXXX"
- Modifiers not showing on claim status view
- DRG Code - Facility
- Type of Bill - Facility
|
Missing/incomplete fields will be added to the response screen. |
TBD |
OPEN |
Spending Account Payment Information
(NY only)
|
Spending account payment information is currently not being returned.
|
Spending account payment information will be available. |
April 2024 |
OPEN |
Authorizations Being Cancelled Incorrectly |
Authorizations submitted via Availity's authorization workflow may be cancelled incorrectly. The error displaying is: "PPO Opt-Out."
NOTE: If the authorization is required, go to Payer Spaces and then access Predictal to submit your authorization.
|
Authorizations will not be cancelled and Availity's authorization workflow will function correctly. |
April 24, 2024 |
OPEN |
Additional Benefits Page in E&B Not Displaying Pharmacy Benefits |
The additional benefits page in E&B is not displaying pharmacy benefits.
|
Pharmacy benefits will be displayed on the additional benefits page. |
TBD |
OPEN |
|
|
|
|
|
Resolved Items
|
Details
|
Resolution
|
Date Completed
|
Status
|
Secondary Modifiers Not Returning on Claim Status
|
Only the primary modifiers are showing on Claim Status response claim line detail.
|
Show all modifiers associated with a claim line on Claim Status responses.
|
April 13, 2024
|
CLOSED
|
Out of Area Authorizations
|
If the user is entering an authorization for an Out of Area (OOA) member, they need to continue use NaviNet.
|
OOA authorizations will be Available in Availity's authorization workflow.
|
March 18, 2024
|
CLOSED
|
Ancillary Providers - Fee Schedule Application
|
A Provider ID needs to be included in the request. Ancillary providers do not have individual providers setup on their accounts and users cannot select a Provider ID this field, preventing it from being able to be completed.
|
The full fee schedule is available on the Provider Resource Center. Access by signing into Availity > Payer Spaces > Highmark > Provider Resource Center
|
March 16, 2024
|
CLOSED
|
Secure Messaging
|
Attachment size currently allows for a total 45MB for 1 – 10 attachments.
|
Allow for attachment total size of 100MB for 1 – 10 attachments.
|
Feb. 17, 2024
|
CLOSED
|
Authorization Submission
|
Currently, authorizations can only be submitted by going to Payer Spaces > Highmark > Predictal.
|
Users will be able to also use the Availity Authorizations workflow (for submissions only).
In the Availity Essentials menu bar, click Patient Registration | Authorizations & Referrals > Authorizations.
The Predictal tile must still be used for authorization status and inquiry.
|
Dec. 2023
|
CLOSED
|
Authorizations for Outpatient Physical Medicine Services
(DE, PA, WV only)
|
If the user is entering an outpatient physical medicine authorization, they currently submit via NaviNet to Tivity.
|
Authorizations for these services are available for submission in Availity and Predictal tile.
|
Dec. 4, 2023
|
CLOSED
|
Additional Benefits/Member ID Cards
|
If a date prior to the current date is inputted in the Eligibility request, the Additional Benefits and Member ID Card buttons will not display. User must enter in the current or a future date to view.
|
Will allow view of benefits/ID cards for previous dates.
|
Nov. 11, 2023
|
CLOSED
|
Claim Status - Member Search
|
If the user is entering the member prefix in the member ID field, the alpha-characters need to be capitalized.
|
Update will ensure alpha-characters are not case sensitive.
|
Nov. 11, 2023
|
CLOSED
|
Claim Status - Member and Claim Tabs
|
Secondary modifiers are not currently returned on response screen.
|
Update will allow secondary modifiers to be viewable.
|
Nov. 11, 2023
|
CLOSED
|