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Upcoming Enhancements
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Details
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Targeted Resolution
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Release Date
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Status
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| 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 |
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Known Issues
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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
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Missing/incomplete fields will be added to the response screen. |
TBD |
OPEN |
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Spending Account Payment Information
(NY only)
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Spending account payment information is currently not being returned.
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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.
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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.
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Pharmacy benefits will be displayed on the additional benefits page. |
TBD |
OPEN |
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Resolved Items
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Details
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Resolution
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Date Completed
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Status
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Secondary Modifiers Not Returning on Claim Status
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Only the primary modifiers are showing on Claim Status response claim line detail.
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Show all modifiers associated with a claim line on Claim Status responses.
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April 13, 2024
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CLOSED
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Out of Area Authorizations
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If the user is entering an authorization for an Out of Area (OOA) member, they need to continue use NaviNet.
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OOA authorizations will be Available in Availity's authorization workflow.
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March 18, 2024
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CLOSED
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Ancillary Providers - Fee Schedule Application
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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.
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The full fee schedule is available on the Provider Resource Center. Access by signing into Availity > Payer Spaces > Highmark > Provider Resource Center
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March 16, 2024
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CLOSED
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Secure Messaging
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Attachment size currently allows for a total 45MB for 1 – 10 attachments.
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Allow for attachment total size of 100MB for 1 – 10 attachments.
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Feb. 17, 2024
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CLOSED
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Authorization Submission
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Currently, authorizations can only be submitted by going to Payer Spaces > Highmark > Predictal.
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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.
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Dec. 2023
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CLOSED
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Authorizations for Outpatient Physical Medicine Services
(DE, PA, WV only)
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If the user is entering an outpatient physical medicine authorization, they currently submit via NaviNet to Tivity.
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Authorizations for these services are available for submission in Availity and Predictal tile.
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Dec. 4, 2023
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CLOSED
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Additional Benefits/Member ID Cards
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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.
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Will allow view of benefits/ID cards for previous dates.
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Nov. 11, 2023
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CLOSED
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Claim Status - Member Search
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If the user is entering the member prefix in the member ID field, the alpha-characters need to be capitalized.
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Update will ensure alpha-characters are not case sensitive.
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Nov. 11, 2023
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CLOSED
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Claim Status - Member and Claim Tabs
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Secondary modifiers are not currently returned on response screen.
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Update will allow secondary modifiers to be viewable.
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Nov. 11, 2023
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CLOSED
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