Online Training

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.

An electronic alternative to paper-based attachment request process. (Limited pilot)

Review several submitted claims using multiple search parameters.

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.

Submit government and commercial claims quickly and receive clams payment faster.

Allows providers to electronically verify a patient’s eligibility and receive contract benefit information quickly and easily.

Access Florida Blue training, including on-demand courses and courses in coding.

Maintain and update your provider information, such as service locations, contact information, providers who join your organization, and when you’re accepting new patients.

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.

Use this tool prior to rendering service to determine the exact amount Florida Blue will pay.

Electronic receipt of claim payments deposited directly into the provider's bank account.

Claims remittance advice that is read electronically by the provider’s internal Practice Management System.

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.

Allows eligible PCP practices a way to compile data and identify cost, quality, utilization and administrative improvement opportunities.

View all of your claim remittances online, eliminating the need for receiving paper remits.

View in real-time: admit, discharge and transfer notices; lab results; and Continuity of Care Documents (CCD).

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.

Digital pre-populated form that enables providers to close care gaps. Required for Medicare Advantage.

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.

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.

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.

Payers can review documentation and request medical record attachments from a provider; providers can fulfill requests for medical records attachments. (Limited pilot)

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.