Conducting Business

Availity Portal - New

Beginning January 1, 2024, we are partnering with Availity to improve payer-provider collaboration and reduce administrative burdens as well as eliminate manual processes and provide more self-service features.

The good news is 91% of our providers are already working in the Availity Essentials portal and can use the same user ID and password to log in to your Essentials account, allowing for a smoother transition. For a refresher, you may view the Reference Guide for Admins and Reference Guide for Users at any time.

If you are new to Availity Essentials, the Get Started page has an abundance of resources, including a recorded webinar that you can watch 24/7 at your convenience. Once you have your Availity Essentials account, navigate to the “Help and Training” button in the upper right-hand corner of your home screen, then select “Get Trained” for additional training options.

In early November you will begin receiving communications directly from Availity announcing the partnership, describing the benefits of their platform, and announcing training opportunities. You can also register today!

Register for Availity Overview for Providers
After registering you can sign up for the Availity Overview for Providers session being held on the dates and times listed below as well as additional training sessions:  
January 3, 2024, at 3:00 p.m.
January 8, 2024, at 1 p.m.
January 10, 2024, at 11 a.m.

Features Available January 1 
Eligibility & Benefits: Obtain eligibility and benefit information for Sentara Health Plans for commercial, Medicaid and Medicare plans.
Claims Submission: Submit claims electronically by completing a claim data entry form for both professional and institutional claims.
Claims Status: Obtain claims status information for Sentara Health Plans for commercial, Medicaid and Medicare plans.
Remittance Viewer: View and print remit information.  Note: The remittance viewer is an option for viewing the remittance and not the only way to receive it. 
Payer Space:

• Connect to the Optima Health and Group Number VP legacy portals to conduct transactions not yet available in Availity, such as authorizations, claims corrections and reconsiderations. 
• Access helpful resources, such as provider manuals, demographic update forms, value based and quality program information and more. 
• Access our newsletters and other important updates and announcements. 

Transitioning to Availity

The change to Availity will occur in three (3) phases.  As a result, the most critical features will be available on January 1st.  To prevent a loss of critical functions or in some cases to immediately provide access to new conveniences, the original portals for both plans will remain available.  However, please note that the pathway to the eventual sunsetting of the Group Numbe VP portal necessitates disabling the auto authorization feature that has been available for select services, effective January 1, 2024.

All providers may register for the Optima Heath Group Number VP portal to submit reconsiderations and appeals electronically.  This is optional and available for your convenience until the feature becomes  available in Availity. 

Please review the matrix below to learn which features will be available in each portal as well as the projected release of new features in Availity.   

If you already registered for Availity, your existing user identification and password will provide access to all payers, including Sentara Health Plans. New passwords will not be required if you have active Group Number VP or Optima Health portal accounts. 

View Claim Status and Submit Reconsiderations and Appeals Online –
• Register for Optima Health portal to perform all existing features, if more convenient.
• Register for Optima Health Group Number VP Portal to view claim status and to submit reconsiderations for Medicare and Medicaid claims until the feature is implemented in Availity

EDI 

W9 will be required effective for EDI enrollment effective January 1, 2024. 

Member Identification Cards Samples

Important Notes:

• Effective 01/01/2024, Sentara Health Plan members will receive new member ID numbers for the former Optima Health Medicaid plans, except for the Optima Health Group VP members (formerly Virginia Premier).   Member ID numbers will remain the same for all other former plans; Virginia Premier DSNP plan, Optima Medicare plans, Optima Medicaid Group VP (Virginia Premier) plan & Optima Commercial plans.
• Group Number VP member ID cards have been discontinued.
• This is not an exhaustive list of Sentara Health Plans member identification cards

Medicaid

Medicare

Commercial

Kaiser Permanente

Famis

Medicaid

Optima Health Group Number VP Portal Access

While we strongly encourage immediate use of the Availity portal, Provider Connection and the Optima Health Group Number VP portal will remain accessible until further notice.

Claims reconsiderations may be submitted for new and existing claims through the Group Number VP claims portal.  Access to the portal will also facilitate business run out.  We anticipate the claims reconsideration feature will become available through Availity during the third quarter of 2024.

You will be able to access the portal through the Availity payer space to:

• View claim status. 
• Submit reconsiderations and appeals.

 

Submitting Provider Updates

This process was integrated in July 2023.  Please notify us as soon as possible of any changes related to your practice’s operations or to the provider roster using our convenient electronic submission process. 

Our provider update process is intended for providers who are currently contracted with Sentara Health Plan or are in the contracting process. If your practice/organization (tax ID) is out of network, and interested in joining our network, please complete the Request for Participation form on the Join our Network page.

Adding a new provider to your practice? Please review the provider credentialing requirements prior to submitting your Provider Update Form.

If you are a participating provider, and need additional assistance related to provider data updates, please email: pustatus@sentara.com