LifeWise Assurance Transition to Availity - Frequently Asked Questions

  • LifeWise Assurance Company is transitioning to Availity's secure multi-payer national platform on September 10, 2022.

    Availity is a free, single-source platform for multiple health plans for checking member eligibility and benefits, submitting prior authorizations and claims, checking status, and more.

    LifeWise Assurance is now live on Availity. Sign in to Availity to access the following tools: 

    • Eligibility & Benefits
    • Prior Authorization
    • Check Prior Authorization Status
    • Claims & Payments
    • Electronic Funds Transfer for enrollment or cancellation

    Access to these tools on the LifeWise Assurance secure provider portal will no longer be available as of September 10, 2022. Make sure your office is ready to go on September 10! Register with Availity and get training.

    Tools

    Which Availity tools are available for LifeWise Assurance?

    • Eligibility and benefits inquiry
    • Claim submission for professional, facility, and dental claims and check claims status (claim submission is free using LifeWise Assurance as the payer)
    • Remittance viewer – including explanation of payments (EOPs)
    • Prior authorization
    • Electronic funds transfer - for enrollment and cancelation

    Which tools remain on the LifeWise Assurance secure provider portal?
    Claims editor and payment policies will remain on the LifeWise Assurance secure provider site and are accessible through the LifeWise Assurance Availity payer space under Resources.

    The LifeWise Assurance public provider website for educational resources will remain long-term, and can be also be accessed through the LifeWise Assurance payer space.


    Access, Payer, Adding a Region/State

    Is Availity available to providers in all states?
    Availity is available in all states.


    I'm not a provider in Washington. Can I use Availity for LifeWise Assurance prior authorizations by adding Washington to my account?
    Yes. Providers outside of Washington can use their current Availity state to submit prior authorizations.


    I don't have LifeWise Assurance as one of my payers, does my administrator need to add this to my log in?
    If you need a state added, have your Availity Administrator contact Availity Client Services at 800-282-4548, 8 a.m. to 8 p.m. ET Monday through Friday. You can also contact them online by selecting Help & Training and then selecting Availity Support.


    How do we get access to other payers on our account?
    Payers are automatically added as they roll out new applications in a state. If a payer has rolled out an app in your state, but you don't see the payer's name in the payer drop-down menu for that state and app, you can contact Availity Client Services for assistance at 800-282-4548, 8 a.m. to 8 p.m. ET, Monday – Friday.


    Prior authorization

    Can I initiate an inpatient prior authorization without uploading documentation?
    No. We need to be able to review the medical reason for the request.


    What about providers who have auto authorization with LifeWise Assurance for specific services? How does that work?
    Clinical criteria is built into the prior authorization workflow that recognizes a provider's TIN approved for auto authorization services. The requester goes through the process flow and won't need to submit any attachments for the request. Once the request is completed, the request is auto approved. The requester can check the status of the request on the Availity Authorization/Referrals dashboard to see it's approved.


    If there are multiple doctors performing a surgery, can you add a co-surgeon to the prior authorization?
    No. The Availity prior authorization workflow includes the requesting provider, rendering provider (or provider providing the service) and facility (if applicable).


    If the member becomes active as of May 1, for example, but the provider is trying to submit the authorization in April, are they able to submit the request online?
    When a provider enters a prior authorization request, an eligibility and benefits check appears. If the member isn't loaded in our system as an active member, it will return a message that the member isn't eligible.


    After a provider sets up an authorization and they want to send additional clinicals, can they come back and attach them after the authorization is submitted?
    No. The provider will need to fax any additional documents to LifeWise Assurance. Please include the request's certification reference number on your fax.


    Will the tool show you or stop you if the prior authorization request has already been submitted, so that you don't duplicate the request?
    No. You'll need to check the Authorization/Referral Dashboard to see what has already been submitted.


    Is there a prior authorization form to fill out?
    No, the Availity prior authorization tool is an online workflow that walks the requester through the process step-by-step. The steps could be different depending on the type of services requested.


    The "rendering provider" is the provider requesting the prior authorization vs. the "servicing provider". Is that correct?
    No., the rendering provider is the same as the servicing provider.


    Can you edit the servicing provider after it's submitted?
    No, once a request is submitted, no additional changes can be made to the request.


    Is this limited to prior authorizations or can requests for additional services be completed through Availity?
    This is limited to prior authorizations only.


    Can a specialist submit a prior authorization or only the primary care doctor? Can prior authorizations be retro?
    Authorizations for procedures can be submitted by either a specialist or a PCP. They should not be retro as they need to be approved before the service is performed.


    Can prior authorization requests be requested for inpatient, outpatient, and specialty office visits?
    Office visits would be a referral. Admissions and services are subject to prior authorization.


    How can I use the Availity authorization dashboard? Can we filter by CPT code?
    No, but you can filter/search by payer, service type, cert number, patient name, dates, etc.


    Are the uploads .PDF only?
    Availity accepts several different file types. The different types of files are noted on the attachments page. Files must be in doc, docx, gif, htm, jpg, pdf, png, ppt, pptx, tif, txt, xls or xlsx format, no more than 10 files may be added.


    Is there an easy way to pin the transaction IDs to my Availity dashboard?
    If you're referencing the Availity transaction ID associated with the Authorization Request, this can't be pinned to your Auth/Referral dashboard. Availity Client Services can use other information to locate the prior authorization request if you call for assistance and don't have the transaction ID for the request.


    We're an ambulance company that provides air and ground services. We send our records through email and mail to LifeWise Assurance. Are we able to send these records through Availity? If LifeWise Assurance isn't listed, do we need to contact the client services?
    You can submit your request for air/ground services and attach records with your requests.


    What does the red triangle with the exclamation in the dashboard mean?
    This is a message from the payer. If you hover over it, you'll see specific details.


    Will we be able to authorize medications through Availity or is that only for procedures?
    Medical drugs such as infusions can be requested in Availity. View all pharmacy drugs requiring approval and how to request approval.

    Prior authorization timing, status, follow-up

    What is LifeWise Assurance's timeframe to complete a prior authorization?
    Authorization requests are submitted to LifeWise Assurance in real-time. We typically respond to requests within 5 days, but it may take up to 15 days if we need additional information. Check your Auth/Referral dashboard after submitting the authorization request for status.


    Do you have to have the provider on your account to follow up on prior authorization requests?
    You can manually enter provider information, so adding them to your account via the Add Providers process on the Manage My Organization page is optional. However, adding them helps you choose them from the Select a Provider drop down which will auto-fill their information.


    Do you ever get an automatic approval or do they all pend for review?
    Yes, some requests are auto-approved. Some services can be auto-approved based on the provider's TIN or service(s) and diagnosis(es) being requested. In this case you won't be required to provide additional information.


    For the Authorization Inquiry page, how long does it take for a prior authorization completed by phone or fax to be loaded?
    We don't take prior authorizations by phone. The speed of loading a faxed request completely depends on the volume of faxes received. Submitting online through Availity gives you a faster response.


    How would I submit handwritten notes and/or chart notes with my prior authorization request?
    You can upload handwritten notes as a .PDF and attach it to your request. We can accept all types of files, including doc, docx, gif, htm, jpg, pdf, png, ppt, pptx, tif, txt, xls or xlsx.

    Can this be used for retroactive prior authorization submissions?
    Prior authorization needs to happen before the service is performed; after that you would submit a claim.


    Codes, code check tool

    On the code check feature if a code requires review, but doesn't need it in certain situations (i.e., some codes don't need review for members under a certain age or when billed with a certain diagnosis) will it alert them of that information or stop them from submitting?
    The tool will do auto authorizations based on a specific code and diagnosis being submitted. As for stopping them, the prior authorization process flow won't stop the requester. The requester goes through the process flow and won't need to submit any attachments for the request. Once the request is completed, the request is auto approved. The requester can check the status of the request on the Availity Authorization/Referrals dashboard to see it's approved.


    Does the code check tool provide member-specific benefit information for prior auths?
    The standalone code check tool doesn't provide member-specific benefit information. The prior authorization check to see if a code requires prior authorization done through the Authorization process flow does include member-specific benefit information about the member's referral requirements and out-of-network benefits.


    I work at a residential substance abuse facility. We use ICD-10 codes, not procedure codes. How does that work in Availity?
    This would be an inpatient prior authorization request and we would accept ICD-10 diagnosis codes.


    What happens if you have more than three diagnosis codes?
    Currently, the Availity tool only accepts 3 diagnosis codes. If you have more than three, you can include the additional diagnosis codes in the Provider Notes section.


    What if I don't have a procedure code to add to my request?
    For inpatient notification requests, you don't need to add a procedure code. There will not be one for Lower Level of Care admissions.


    Vendors: EviCore, AIM, Evolent

    Can I submit requests for AIM or eviCore through Availity?
    If requesting services through Availity, you'll be directed to complete the request through AIM or eviCore.


    Do I submit prior authorizations through Availity for high-tech imaging?
    Most of our imaging is reviewed by AIM; if the service requires prior authorization, you'll be directed to AIM.


    For Washington, most of our LifeWise Assurance prior authorization requests for PT and OT go through eviCore after 6 visits. Can we submit through Availity instead, or do we still need to submit through eviCore?
    If you submit your requests through eviCore today, you'll continue to submit through eviCore. If requesting services through Availity, you'll be directed to complete the request through AIM or eviCore.


    Do prior authorizations for individual plans go through Availity now?
    No, you will need to continue to go through Evolent secure portal for individual plans.


    Does everyone have access to AIM? It's not listed on my account.
    AIM is a third-party vendor for certain types of services. If a service is required to be completed by AIM, you'll be directed by the health plan payer to complete your request through AIM.


    Does Availity alert the user if the code requires review by AIM or eviCore?
    Yes. The process flow for prior authorizations includes a check to see if a code requires prior authorization before completing a request. If a code requires prior authorization through AIM or eviCore, the response will include a message and a link to the AIM or eviCore website. The requester can't move forward with completing the request through Availity.


    Does this mean we no longer go through eviCore for any LifeWise Assurance members?
    Prior authorization service requests that go through eviCore today will continue to go through eviCore. 


    For radiation services, can I bypass Availity and go directly to AIM?
    Yes, you can do a code check and if it's an AIM code, a link will display to take you directly to the AIM website.


    Denials, appeals

    Once a case is processed, can you view the denial letter on the portal, or at least the reason for denial criteria?
    No, not at this time. It will give you a denial and a denial reason and you'll get a separate letter with the denial details.


    If a prior authorization request is denied, is the denial letter available in Availity?
    No. The denial letter is sent directly to the member and the requesting provider. 


    Will Availity provide a denial reason?
    Yes, but Availity only provides a high-level denial reason.  The denial letter provides complete details.


    Are the denial and approval letters faxed?
    Yes, the letters are faxed to the requesting provider.


    When a prior authorization is denied, is there an option to appeal through Availity such as a peer-to-peer review or a phone number to call?
    Not at this time. Details about appeals are in the denial letters.


    Can we appeal through Availity?
    Not at this time. LifeWise Assurance requires a signed member authorization for all appeals submitted on the member's behalf. The member appeal form includes an authorization section for the member to sign and date. Providers need to coordinate the submission of appeals with the member as the signed member appeal form must be included with any supporting documentation or medical records relevant to the appeal. Appeals related to contracted rates or provider payments aren't member appeals and don't require member authorization.


    OneHealthPort

    Does this mean OneHealthPort (OHP) is going away?
    No. OHP remains as our gateway vendor for single sign-on activity. Instead of signing in repeatedly to multiple health plan portals, OHP users sign in just once and get secure authentication for many health plans. The Availity sign-in button is located on the OHP LifeWise Assurance plan splash pages.


    Will the LifeWise Assurance secure legacy portal, accessed through OneHealthPort (OHP), still process requests for prior authorization?
    We'll continue to use OHP for single sign on authentication. LifeWise Assurance secure provider tools will transition to Availity starting September 10. Register and get training.


    Training

    How do I get more Availity training?
    If you need an intro to Availity, sign in and select Help & Training > Get Trained. That will open the Availity Learning Center. In the lower-left corner, you can search by category, such as Getting Started/Onboarding. You can also contact Training@Availity.com if you have questions specific to training or contact Availity Client Services at 800-282-4548, Monday through Friday, 8 a.m. to 8 p.m. ET.



    Technical issues, support resources

    If I have technical issues with Availity, who do I call?
    Providers can call Availity Client Services at 800-282-4548, Monday-Friday, 8 a.m. to 8 p.m., ET. Existing Availity users can sign in and select Help & Training > My Support Tickets to submit an online support request or chat online.


    What if we try to set up an Availity account and find that one already exists? Does it provide the administrator's name?
    For security purposes, no, it doesn't give the administrator's name. To find out who your Availity administrator is, call Availity Client Services at 800-282-4548, Monday-Friday, 8 a.m. to 8 p.m., ET.


    Where do I call if I have issues with OneHealthPort?
    For OneHealthPort account or log-in questions, call 800-973-4797.


    Will we receive an error message or be guided to contact the health plan?
    If you receive an error message while using the Availity tools, please reach out to Availity Client Services at 800-282-4548, Monday through Friday, 8 a.m. to 8 p.m. ET. You can also reach them online by selecting Help & Training in the top navigation bar and then selecting Availity Support.


    General/other

    What's the difference between Availity and Availity Essentials?
    They're essentially the same. Availity, LLC., is the company name. Availity Essentials the new name of the secure tool portal where you can work electronically with multiple payers through a variety of applications.


    Are there ever updates to the Availity portal that I may have missed? I log in and out all the time.
    We have a major release the third Saturday of every month, except November and December. The releases occur on the second weekend of the month. We provide a release blog through Help & Training > Availity Support. You'll also see updates in the News & Announcements section of the payer spaces.