Availity Editing Services Update March 2025

Date: 03/07/25

Reminder: Availity Claim Editing Services Available

for Ambetter from Arizona Complete Health

In late November 2024, we distributed a communication regarding Ambetter from Arizona Complete Health’s partnership with Availity Editing Services (AES) to return claim rejection messages via AES messages starting January 24, 2025.  In order to complete additional readiness activities, our go live date is now March 26, 2025.

AES can identify a claim error upfront and return a message that allows you to correct the claim before sending it on to Ambetter from Arizona Complete Health to be adjudicated. If you review edit messages for potential corrections to the suggested claim line(s) and make updates to the claim, it may help the claim process correctly the first time, preventing errors, and improving payment accuracy and claims adjudication turnaround time. If, after reviewing the message, you feel it does not apply, you may resubmit the claim as-is and the edit will bypass 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 other downstream edits will still trigger in our claims system. Remember to “submit” your claim regardless of your choice to edit or bypass. Submission is required for the claim to be processed in our system.

If you have a Practice Management System, you can locate your edits report within your claims workbasket or queue reporting. If you submit claims via the Availity portal, these rejections will show in your normal reports.

If you submit claims via Availity, learn how to access 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 that include these edits. Please note although this demo may not use the term AES, it’s the demo that shows the user how to locate the AES reports.

·        EDI Reporting Preferences – Training Demo

This demo shows users how to setup 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 Arizona Complete Health Provider Engagement Specialist.