Learn about Availity Essentials

To submit a claim:

1. From the Availity Essentials home page, select Claims & Payments from the top navigation.
2. Next, select Claims & Encounters from the drop-down menu.

1. From the Availity Essentials home page, select Claims & Payments from the top navigation.
2. Select Claim Status Inquiry from the drop-down menu.

To check claims status or dispute a claim:

1. From the Availity Essentials home page, select Claims & Payments from the top navigation.
2. Select Claim Status from the drop-down menu.
3. Submit an inquiry and review the Claims Status Detail page.
4. If the claim is denied or final, there will be an option to dispute the claim. Select Dispute the Claim to begin the process.

To use Clear Claims Connection:

1. From the Availity Essentials home page, select Payer Spaces from the top navigation.
2. Select the appropriate health plan.
3. From the Payer Spaces home page, select the Applications tab.
4. Select the Clear Claims Connection tile.

To request authorizations:

1. From the Availity Essentials home page, select Patient Registration from the top navigation.
2. Select Auth/Referral Inquiry or Authorizations.

To check if authorization is required:

1. From the Availity Essentials home page, select Payer Spaces from the top navigation.
2. Select the appropriate health plan.
3. From the Payer Spaces home page, select the Applications tab.
4. Select the Prior Authorization Lookup Tool tile.

To check member eligibility and benefits:

1. From the Availity Essentials home page, select Patient Registration from the top navigation.
2. Select Eligibility and Benefits Inquiry.

Note: There’s a separate registration your organization’s administrator needs to complete to access this tool. Please review registration instructions in the Registration for provider online reporting section.

To access member panel listings:

1. From the Availity Essentials home page, select Payer Spaces from the top navigation.
2. Select the appropriate health plan.
3. From the Payer Spaces home page, select the Applications tab.
4. Next, select the Provider Online Reporting tile.
5. Select your Organization and Submit.
6. From the Provider Online Reporting page, select Member Panel Listings.

Note: There is a separate registration that your organization’s administrator needs to complete to access this tool. Please review registration instructions in the Registration for provider online reporting section.

To access member reports:

1. From the Availity Essentials home page, select Payer Spaces from the top navigation.
2. Select the appropriate health plan.
3. From the Payer Spaces home page, select the Applications tab.
4. Next, select the Provider Online Reporting tile.
5. Select your Organization and Submit.
6. From the Provider Online Reporting page, select Member Reports.

Note: Your organization's administrator must complete this registration process and grant access to users in the organization.

To register for provider online reporting:

1. From the Availity Essentials home page, select Payer Spaces from the top navigation.
2. Select the appropriate health plan.
3. From the Payer Spaces home page, select the Applications tab.
4. Next, select the Provider Online Reporting tile.
5. Select your Organization and Submit.
6. Select I Agree on the Disclaimer page.

You will then be redirected and see the message, Welcome to provider online reporting. Your next steps are to:

1. Select Register/Maintain Organization to register your organization’s tax ID to the applicable program.
2. Select Register Tax ID to register for the eligible program (member reports or panel listings).
3. Select Maintain User/Register User to grant access to users.
4. Complete all fields on the Register User page. Select ADD TO PREVIEW and Save.
5. Go to Report Search, select the program, complete the required fields and select Search.
6. A file should now be available.

To access provider online reporting for all users once registration is completed:

1. From the Payer Spaces home page, select the Applications tab.
2. Select Provider Online Reporting.
3. Select your Organization and Submit.
4. Select I Agree on the Disclaimer page.
5. Go to Report Search, select the program, complete the required fields and select Search.
6. A file should now be available.

To access Total Member View:

1. From the Availity Essentials home page, select Payer Spaces from the top navigation.
2. Select the appropriate health plan.
3. From the Payer Spaces home page, select the Applications tab.
4. Select the Total Member View  tile.