More . . .
- Online Training
- Medical & Pharmacy Policies and Guidelines
- Manual for Physicians and Providers
- Marketplace Health Plans (myBlue, BlueCare HMO, BlueOptions, BlueSelect)
- Important News
- Federal Employee Program®
- Medicare Stars
- Quality / HEDIS / CAHPS®
- Companion Documents /
Whether you’ve recently joined our provider network, added a physician to your team or simply need the latest updates on provider information and tools, you’ll find all your online training needs here.
When it comes to self-service, we understand that convenience, ease of use and speed are important to you. That’s why we offer a variety of self-service tools and training to support our providers. Our self-service tools are conveniently located on availity.com.
Stay up-to-date on the latest provider training and self-service tools. Availity® offers a variety of on-demand training options for physicians, office managers, staff and others.
For registered Availity users, login on the Availity portal at availity.com, then click Help & Training (top right corner), then Get Trained. You will land in the Catalog where you can register for on-demand training that you can access at your convenience.
Questions about training? Contact the Availity Learning Center at firstname.lastname@example.org.
Types of Self-ServiceTools and Definitions
Click on each + for the definition of the tool.
- Authorizations and
Quickly request authorizations and referrals, and also check the status or modify an existing request. Enhanced referral feature helps ensure a requesting provider selects a specialist that participates with the specific member plan type when a referral is required.
- Claim Attachments
An electronic alternative to paper-based attachment request process. (Limited pilot)
- Claim Status (new)
Review several submitted claims using multiple search parameters.
- Claim Status Inquiry
An easy way to check the status of a claim (that was not processed real-time or waiting on a response) and find out information about denied or delayed claims.
- Electronic Claim
Submit government and commercial claims quickly and receive clams payment faster.
- Eligibility and Benefits
Allows providers to electronically verify a patient’s eligibility and receive contract benefit information quickly and easily.
- Florida Blue Learning
Access Florida Blue training, including on-demand courses and courses in coding.
- Provider Data
Maintain and update your provider information, such as service locations, contact information, providers who join your organization, and when you’re accepting new patients.
- Real-Time Claim
Combines patient financial responsibility information with real-time claim adjudication to provide patient responsibility at time of service. Accessible through CareCalc and claim submission on availity.com.
- Patient Cost Estimator
Use this tool prior to rendering service to determine the exact amount Florida Blue will pay.
- Electronic Funds
Electronic receipt of claim payments deposited directly into the provider's bank account.
- Electronic Remittance
Claims remittance advice that is read electronically by the provider’s internal Practice Management System.
- Overpayment Recovery
Track, manage and respond to requests for recovering overpayments. Submit disputes or inquiries; complete and submit forms to resolve requests; retrieve or attach documents; and review overpayment history.
- Quality Efficiency
Allows eligible PCP practices a way to compile data and identify cost, quality, utilization and administrative improvement opportunities.
- Remittance Viewer
View all of your claim remittances online, eliminating the need for receiving paper remits.
- Admit / Discharge /
View in real-time: admit, discharge and transfer notices; lab results; and Continuity of Care Documents (CCD).
- Care and Coding
Clinical, claims and pharmacy data is used to display potential gaps in our members’ care. These reminders support medical care that may not have been addressed, e.g. mammogram, colonoscopy, flu shot. Care reminders are located within both Eligibility & Benefits and the Patient Care Summary.
Coding gaps are also located within Eligibility & Benefits Care Reminders. Coding gaps are inconsistencies between encounter documentation and claim diagnosis codes, e.g. physician documentation states a diagnosis of diabetes, but the submitted claim does not include a diagnosis code for diabetes.
- Clinical Quality
Digital pre-populated form that enables providers to close care gaps. Required for Medicare Advantage.
- Comprehensive Quality
and Risk Health
Provides the capability to show known, suspected and dropped conditions that may impact members under a provider’s care. Also allows a simplified interface for sending information between providers and Florida Blue to confirm, close or correct coding info. (CQRP assessment forms for patient encounters in 2017 must be submitted by February 28, 2018. All 2018 encounters are handled through the Quality Engagement Program.)
Available to PCPs to review hospital admission, discharge and transfer information for their attributed Florida Blue Medicare HMO and myBlue members.
- Electronic Appeals
Submit your clinical or administrative appeals with all supporting documentation, saving time, postage and money. Also track clinical appeal status through the Task List within the tool.
- Enhanced Medication
Allows PCPs to receive medication action plans for our Medicare D members who have chronic health conditions. The PCP is able to make adjustments to the medication plans and also refer patients to a specialist if needed.
- Medical Records Extract
Payers can review documentation and request medical record attachments from a provider; providers can fulfill requests for medical records attachments. (Limited pilot)
- Patient Care Summary
Assists providers in obtaining patient's history intake at time of service; improves care delivery by recording patient history, avoiding potential medical errors and duplicating therapies; and improves revenue through awareness of gaps to be closed.
- QERP Access Administrator Instructions, July 2017
- Electronic Appeals
- Clinical Form Training Guide and FAQs, August 2015
- Electronic Provider Access
Risk Adjustment Process On Demand and Live Training from Florida Blue
Risk adjustment training provides insight on best practices for documentation and coding accuracy. Learning about the importance of documenting complete and accurate health information within the medical record, including appropriate diagnosis codes of a condition, helps ensure accurate diagnosis coding:
Risk Adjustment 101
Risk Adjustment: Adjust Your Thinking About Documentation and Coding
Documentation and Coding Training Series (cancer, COPD, diabetes, chronic kidney disease, mental health, rheumatoid arthritis, risk adjustment)
For registered Availity® users, log in to the Availity portal at availity.com, click Payer Spaces and select Florida Blue. On the Applications tab, click Access Florida Blue Learning & Development. You will land in the Catalog where you can enroll for on-demand and live training. Please allow a few minutes for presentations to load. Some of these presentations may include audio, so remember to turn up your volume.
- Provider Distinction: People with Disabilities
- How to Identify Our Health Plans - 10 minutes
- Programs and Processes at a Glance - 8 minutes
- Understanding the BlueCard Program - 9 minutes
- NCCI Edits
- Modifier AS
- Modifier 25
- Modifier 57
- Finding the Correct Path to Modifiers 59, XE, XS, XP and XU
- Submission of Complete Diagnosis Codes for Non-Institutional Claims
- BlueCare Basics - 7 minutes
- BlueOptions - 6 minutes
- BlueSelect - 6 minutes
- FamilyBlue Medical Discount Card - 5 minutes
Medicare Part D
- Cultural Competency for Health Care Providers - 42 minutes
- Provider Appeals - 7 minutes
- Comfort Blue Hospice Case Management System - 5 minutes
- Financial Programs - 5 minutes
- Florida Blue Retail Centers - 3 minutes
- Overpayment Recovery Program Changes - 3 minutes
- Claims Paper and Electronic Submissions - 10 minutes
FB PRV TLS 002 NF 112017