Top 10 tips to help you get the most out of Availity Essentials
As you are aware, providers now use Availity Essentials for Magellan member eligibility and benefits, and claims inquiry functions.
The following tips/FAQs can help you get the most out of the portal. Bookmark this page, or print this tip sheet for future reference (PDF).
1. Why aren't benefits displaying for the member?
If the member’s benefits do not appear, it could be that Magellan does not “load” the benefits for that plan (e.g., Blue Shield of California ASO or a state/government-sponsored program). In those cases, you’ll need to contact the appropriate Magellan service center. Refer to the message/disclaimer at the bottom of the transaction page for guidance.
2. What member number should I use for an eligibility and benefits search?
You can search for a member’s eligibility in Availity Essentials in two ways:
- Use the member ID on the member’s insurance benefits card. If you receive an error, try entering the number without the prefix or suffix.
- Search for a member without entering an ID number, by using patient name and patient date of birth.
If you still receive an error message, then the member may not be active within Magellan’s system.
3. Where can I find help on what to enter in a specific field?
Hover over the help buttons (?) next to the field for additional information at a payer level.
4. How can I submit claims?
The claims submission process has not changed, i.e., how you submitted claims in the past is still available to you today – use the MagellanProvider.com Submit a Claim Online application, direct-submit professional claims, or use a clearinghouse (Availity is also a clearinghouse option).
5. What if I don't get results when I search in Availity Essentials Remittance Viewer?
- You must authenticate a check to view remittance information from Magellan.
- Select the appropriate label for the search criteria.
- Clear all filters from your previous search.
- Clear your browser cache.
6. I can't find the denial reason in Availity Essentials.
Using Remittance Viewer, in the explanation of benefit (EOB)/explanation of payment (EOP) detail, refer to one or a combination of Business Scenario, Remittance Adjustment Remark Codes and/or Claim Adjustment Code Desc displayed for the denial reason explanation.
7. I want to see the full EOB details instead of one claim at a time.
In Remittance Viewer, on the Check/EFT tab, choose the Download button (under Actions, on the right) and select the viewing option you prefer. TIP: By selecting Check Summary for Multiple Claims Per Page you’ll see a full check/EFT summary. The file will download as a PDF that you can print and save.
8. Claim Status in Availity Essentials doesn't have as much detail as Magellan's site did.
Although the layout differs from what you were used to seeing on MagellanProvider.com, all the same information is in Availity Essentials. You can view it using a combination of the information within the Claims Status and the Remittance Viewer functions.
9. The check amount in Availity Essentials is different than what I received.
This difference is due to your claim having been adjusted. To understand how your claim was adjusted, you will see two line-items for the same Check/EFT number. The difference between the original payment amount and the adjusted amount are under the same Check/EFT number.
Select Remittance Viewer from the top navigation (Claims & Payments > Remittance Viewer):
- Search by claim number.
- Click the Search button to see all remittance related to the claim.
- Original adjudication, adjustment reversal, and final adjudication display as separate lines.
10. Why do I see a "Payer Unavailable" message?
When cyber traffic is heavy, it may take longer than expected for Availity’s systems to receive the requested data from Magellan.
Check Availity’s system outage notice (Help & Training > View Network Outage) to see if Magellan is on the list. You can review your request later to see if results returned (the Eligibility & Benefits function keeps your card open) or try again in 30 minutes or so.
For more resources, including a claims status/remittance viewer crosswalk (PDF), visit MagellanProvider.com/Availity.