Beginning June 15, 2024, Availity’s Appeals application will be expanded to include medical pre-authorization determination appeals. Any pre-authorization on the Authorization dashboard can be appealed using the new appeals function.
The application streamlines the appeals process, allowing users to submit a medical pre-authorization determination appeal with required documentation directly from the Authorization dashboard, receive immediate confirmation of submission and review the status of their appeal—all in one place. Pre-authorizations appear on the dashboard when they are submitted using the Authorization application or by submitting an inquiry and pinning the authorization to the Authorization dashboard.
The Appeals dashboard will show the status of submitted appeals. Access it from Availity Essentials: Claims & Payments>Appeals.
This new functionality does not apply to:
- Pharmacy pre-authorization
- Pre-authorizations submitted via eviCore (physical medicine) or Carelon (radiology, sleep medicine or cardiology)
Get trained for free
View the training options available in the Availity Essentials menu: Help & Training>Get Trained. Search for pre-authorization appeals.
6/13/2024
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