We’ve completed our transition to the Availity Essentials portal, but we’re not done! We’re still enhancing what we have already implemented and building out important new self-service options for you. Here are a few value adds to watch for in the coming months:
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Unsolicited claim attachments: You will be able to proactively send us records with your claims and add attachments via the Availity portal claim status feature. Includes a dashboard.
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Prior auth dashboard update: The status you see on the dashboard will be the most recent (no need to click).
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Claim follow-up action app: This revised Payer Space app will allow you to initiate a claim dispute or notify us of an overpayment.
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Reasons for pended and denied claims: We’re already displaying these reason codes and remarks for most claims. Our update will let you see them for Federal Employee Program® (FEP®) claims, too.
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Search fees by specialty app: This new Payer Space app will allow you to search fees by specialty.
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Prior auth request results: You will see much quicker turnaround times for auth requests sent via the Availity portal.
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Credentialing status app: This new Payer Space app will allow you to check a provider’s credentialing status.
If you have questions about how to use the Availity portal features, don’t hesitate to reach out to the Availity Client Services team at 800-282-4548. If you missed the recent webinars, you can watch the AZ Blue Availity Webinar video recording.
Updates effective December 1
Updated medical policy for bioengineered skin and soft tissue substitutes
Effective December 1, 2026, the updated Bioengineered Skin and Soft Tissue Substitutes medical policy will be more specific about what is considered not medically necessary for wound care treatments using bioengineered skin and soft tissue substitutes. The policy applies to commercial and Medicare Advantage lines of business. It does not apply to FEP plans.
Updated prior auth requirements for FEP plans
Effective December 1, prior authorization requirements for FEP plans will be updated. Several codes (many of them drug codes) will be added. Others will be removed, and some existing codes will only require prior auth for certain diagnoses. For some codes, FEP is changing the applicable plans. Preview the list of FEP prior auth requirements updates.
Clear Claim Connection (C3) tool to be discontinued
Starting December 1, access to the C3 claim edit tool will be removed from our Availity Payer Space. Because the tool can only return information on a limited portion of our edits, it can’t give you a complete picture of how your claim will process through our system. Please share this change with staff members who use the tool.
Reminders about updates that start October 1
Secondary claim coding edits
In November, we will add secondary code edits to our claim processing system. This will help us adjudicate claims in alignment with nationally recognized coding standards and payment practices. The new secondary claim edits are included in the updated Medical Code Edit Guidelines document. You can find it in the Availity portal at “Payer Spaces > AZ Blue > Applications > Claim Coding Resources.”
To avoid denied claim lines when the secondary edits are applied, review your current coding and billing practices, including the use of modifiers, to see if any updates are needed. Be sure your clinical documentation supports all billed services.
New medical policy for experimental/investigational services
Effective November 1, our new medical policy for experimental and investigational (E&I) services defines the applicable criteria for E&I determinations. It includes a list of codes currently considered E&I and not covered unless otherwise specified in another medical policy used by AZ Blue.
In case you missed these two October 1 medical policy updates
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Applied Behavior Analysis (ABA)
For dates of service on and after October 1, our new proprietary ABA policy has replaced the current MCG guideline for ABA services. The new ABA policy applies to commercial and FEP plans. It does not apply to Medicare Advantage plans. We have updated the ABA documentation requirements to align with the new AZ Blue policy.
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Implantable Shock Absorbers for Treatment of Knee Osteoarthritis
This new policy addresses the use of implantable shock absorber technology, including the MISHA™ Knee System, for the treatment of knee osteoarthritis. It is considered experimental/investigational and not covered for commercial and FEP plans. The policy does not apply to Medicare Advantage plans.
For PCPs: This free, one-hour CME course equips PCPs with practical, evidence-based strategies to diagnose dementia, communicate effectively with patients and families, manage symptoms, coordinate care, and confidently guide patients throughout the dementia journey. This on-demand course features leading dementia care experts from Mayo Clinic Neurology, Honor Health, Barrow Neurological Institute, Banner Alzheimer’s Institute, and Hospice of the Valley’s Dementia Care and Education Campus. When you’re ready, you can access the module here: https://physician-dechov.talentlms.com/.
Availity is a separate, independent company contracted with AZ Blue for provider portal services. Availity is a registered service mark and Availity Essentials is a service mark of Availity, LLC.
The MCG care guidelines are the proprietary and copyright-protected information of MCG Health, part of the Hearst Health network.
MISHA is a trademark of Moximed, Inc.
Policy Center for Maternal Mental Health is a trademark of 2020 MOM.
Blue Cross, Blue Shield, the Cross and Shield Symbols, Federal Employee Program, FEP, and BlueCard are registered service marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.
