Q4 2024 Provider Newsletter

Date: 12/16/24

2025 Core Renaming to Premier 

Ambetter of Alabama is appreciative of your participation in our provider network and the care you provide our members. Each year, we conduct a comprehensive review of our market operations and footprint to best align our network strategy and resources.

Beginning January 1, 2025, the Bronze | Silver | Gold network will be renamed to the PREMIER network. Members will be notified through various upcoming notifications and will see this change on Ambetter Guide.

While our plan offerings are changing, our commitment to delivering quality care and services to our members is unwavering. Thank you for your continued partnership as we work to transform the health of the communities we serve, one person at a time.

Quality Updates

HELPING YOU CARE FOR YOUR PATIENTS IS OUR TOP PRIORITY.

Strong communication and trust between you and your patients will help ensure they are satisfied and have good outcomes. You can rely on Ambetter of Alabama for information and support to help you keep those patient relationships strong.

Annual Qualified Health Plan (QHP) Enrollee Experience Survey

Happening February Through May 2025

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Health Plan Survey is an opportunity for your patients to share their healthcare experiences with you as their provider and with their health plan. Your patients are asked specific questions which include how well their doctor communicates, if they felt their doctor listened to them, and if their doctor explained things in a way that was easy to understand. Also included are questions on how well different healthcare providers are communicating about care coordination and a (0-10) rating of the patient’s overall satisfaction with their healthcare, personal doctor, and specialists.

Annual Provider Satisfaction Survey

You are essential to providing the highest quality healthcare possible for our members, and your satisfaction is very important to us, too. We assess your experience with us through an annual Provider Satisfaction Survey. These survey results are reviewed by the health plan and are key to helping us improve your experience, so please be sure to complete the survey if you receive one.

Our support doesn’t stop there.

Our provider website contains essential information, including member surveys, health equity resources, language services and resources, provider credentialing rights, the utilization management process, how to access care management services and other sources of support for you. Read more now: https://www.ambetterhealth.com/en/al/provider-resources/providing-quality-care/.

If you have additional questions or need specific support, call Provider Services at 1-800-442-1623.

Provider Resources 

Our 2025 Provider Manual is ready! You can find a variety of resources on this page including the current 2024 Provider Manual, Quality and Risk Adjustment resources, and various provider education.

Please view the new claims dispute form HERE, along revised clinical policies. The changes can be found on the Clinical & Payment Policies page

Have you had recent changes to your practice such as new providers, new locations, or similar? We are glad to help you with making those changes effective to prevent delays in processing claims. This will also ensure your practice displays correctly in our directory. Our Provider Network Operations team supports our providers by assisting with the following:

• Demographic Updates and Changes
• Adding Providers to existing Groups or Practices
• Provider Termination Requests

Please submit updates within 30 days of data change becoming effective to our Provider Network Operations team by emailing your request to the email address below. You can also use our roster form if you have a large number of updates. Email us at: sm_ambetteralops@centene.com

Availity Portal Goes Live Monday, November 18th

Ambetter of Alabama has chosen Availity Essentials as its new, secure provider portal. Starting Monday, November 18th, you can validate eligibility and benefits, submit claims, check claim status, submit authorizations, and access Ambetter of Alabama payer resources via Availity Essentials. Live training opportunities are listed below. Please Note: You must be logged into your Availity Essentials account to register and attend live training.

You can log in to your existing Essentials account (https://apps.availity.com/availity/web/public.elegant.login) to enjoy these benefits for Ambetter of Alabama Plan’s members beginning November 18th. Our current secure portal will still be available for other functions you may use today.

If you are new to Availity Essentials, getting your Essentials account is the first step toward working with Ambetter of Alabama on Availity.  Your provider organization’s designated Availity administrator is the person responsible for registering your organization in Essentials and managing user accounts. This person should have legal authority to sign agreements for your organization. If you are the administrator, you can register and get started with Availity Essentials at https://www.availity.com/documents/learning/LP_AP_GetStarted/index.html#/

Enroll in a Live Training:

Instructions to enrolling for a provider webinar in the Availity Learning Center (ALC):   

1. Log in to Availity Essentials.
2. Select Help & Training > Get Trained.
3. ALC opens in a new browser tab. **If it does not, have the user check their browser settings to allow for pop-ups and redirects from apps.availity.com and availitylearning.learnupon.com. **
4. Select the Sessions tab.
5. Select the View Course button next to the webinar.
6. Select the Enroll button.

Live Training Topics and Dates:

*Availity Essentials Introduction

• Monday, Nov. 18 – 3 p.m. EST
• Monday, Dec. 2– 2 p.m. EST

*Authorization Tools

• Tuesday, Nov. 19 – 2 p.m. EST
• Tuesday, Dec. 3 – 12:30 p.m. EST

*Claim Submission

• Wednesday, Nov. 20 – 11 a.m. EST
• Wednesday, Dec. 4 – 12 p.m. EST

*Claims Follow-up Tools

• Thursday, Nov. 21 – 3:30 p.m. EST
• Thursday, Dec. 5 – 1 p.m. EST

*Risk & Quality Applications

• Thursday, Nov. 21 – 11 a.m. EST
• Tuesday, Dec. 4– 10:30 a.m. EST

If you need additional assistance with your registration, please call Availity Client Services at 1-800-AVAILITY (282-4548). Assistance is available Monday through Friday, 8 a.m. – 8 p.m. ET.

Availity Editing Services

In a continuous effort to make it easier to do business with us, Ambetter of Alabama is introducing Availity Editing Services (AES). Starting Jan. 24, 2025, Centene is partnering with Availity to return rejection messages on its behalf via AES messages. These messages will show in your existing workflows. AES will give you an option, but not a requirement, to edit a claim. 

AES can identify a claim error upfront and return a message to you for correction before sending the claim on to the plan to be adjudicated. You should review edit messages for potential corrections to the suggested claim line(s). If you make updates to the claim, this may help the claim process correctly the first time, preventing errors, improving payment accuracy, and claims adjudication turnaround time. If, after reviewing the message, you find it does not apply, please resubmit the claim as-is and this will allow a bypass of the edit in cases where it may not be applicable.

This is not intended as a new method to deny a claim, nor does it bypass or replace downstream edits. If you choose to bypass an edit, it is possible that other downstream edits will still function as normal in our claims systems. Remember to “submit” your claim regardless of your choice to edit or bypass. This action is required in order for the claim to be processed in our systems. 

If you have a Practice Management System (PMS), you can locate your edits report within your claims workbasket or que reporting. If you submit claims via the Availity portal, any of these rejections will show on your normal reports.

If you submit claims via Availity, learn how to gather your reporting by joining one of Availity’s free webinars to learn additional tips for streamlining your workflow:

• Send and Receive EDI Files – Training Demo
  This demo shows users where/how they can access reports in Availity Essentials. On these reports are where they would see edits. Please note: this demo does not say/call it AES however, this is the demo that would show the user how to locate the reports.
• EDI Reporting Preferences – Training Demo
  This demo shows users how to setup their EDI Reporting Preferences which needs to be done first by the user’s organization’s Availity Administrator to access the reports in the Send and Receive EDI Files application.

If you need assistance with registering for Availity Essentials, please call Availity Client Services at 1-800-AVAILITY (282-4548). Assistance is available Monday through Friday, 8 a.m. – 8 p.m. ET. For general questions, please reach out to your Ambetter of Alabama Provider Engagement Representative. 

Appointment Availability & Wait Times

Ambetter follows the accessibility and appointment wait time requirements set forth by applicable regulatory and accrediting agencies. Ambetter monitors participating provider compliance with these standards at least annually and will use the results of appointment standards monitoring to ensure adequate appointment availability and access to care and to reduce inappropriate emergency room utilization. This updated information can be accessed in the 2025 Provider & Billing Manual HERE.

REMINDERS

2024 Provider Satisfaction Survey has LAUNCHED!

Thank you for being a valued partner in our provider network!

If you receive a survey from us, please provide honest feedback regarding your experience with us. Sharing your experience in this brief survey is how you can help us gain valuable insights to enhance and improve provider tools, resources, and operations to better support you.

We look forward to receiving your valuable feedback. Thank you!

• As a reminder open enrollment has started, it began November 1st, 2024, and goes through January 15th, 2025.
• Please utilize all features & functions found in our Ambetter of AL website.
• Remember to contact your Provider Engagement Administrator with any demographic updates.
• Providers can create an account or login to our portal HERE.

Do you have ideas for the newsletter? Please contact Lekisha Grier.