Availity "Oops" Causes Cash Flow Delays
Posted by Lin Dworshak on Sat, Sep 03, 2011 @ 11:53 AM
On August 22, 2011, the Availity (Blue Cross/Blue Shield) Web Portal upgraded to the 5010 format. MedPro Solutions (a billing company located in Pensacola, Florida) submitted $48,000 in charges ( 90 claims) through the portal for processing. One of the touted advantages for using the Availity product is the ability to view immediately whether the claim is considered a "clean claim" or will be denied for some reason. The claims submitted by MPS were in the appropriate 5010 format (MPS having upgraded to 5010 format previously) and the expectation was clean claims
Immediately staff , upon review of claims submitted, saw error messages and issues with recognition of alpha/numeric modifiers.
MPS management contacted Availity to report error messages. Availity were unaware of issue and began to investigate the problem. Six days later, the problem was corrected.
Six days of cash flow lag, more charges held and not submitted because of problem and cash normally posted to AR before month end was not realized.
MedPro Solutions, continuously aware of cash flow delay implications, has and will continue to assertively demand swift corrections to carrier and third party vendor software issues as the 5010 deadline quickly approaches.
Make sure you are testing and verifying your third party carriers are meeting expectation of 5010 compliance accurately.