Delay of Claim Appeals in Availity Essentials

We’re committed to making it easier for you to submit and track claim appeals through Availity. To ensure a better experience, we’re temporarily delaying the rollout of the Availity claim appeals feature while we improve operations and appeal intake quality.

Why this matters
We continue to experience a significant increase in appeal volume, including submissions that aren’t true appeals or are missing required information. These issues require manual review and can delay processing for all providers.

What you can do now
Help reduce your administrative waste and help us process appeals more efficiently by following these guidelines:

• Submit corrected claims when appropriate
  Please do not submit appeals for claims related to primary EOB or coordination of benefits (COB). When within timely filing limits, submit a corrected claim with supporting documentation instead.
• Include complete rationale and documentation
  Clearly include a description of the issue in the dispute, evidence to support the request, and a description of the relief sought. Missing information may delay or prevent review.
• Avoid incomplete or vague submissions
  Appeals without clear rationale or supporting evidence, including generic or AI-generated content, require additional follow-up and slow overall processing.
• Include member authorization when required
  If submitting on behalf of a member (e.g., for patient responsibility), please include a signed authorization form to prevent delays or rejection.
• Use the correct forms

Make sure you’re using the correct appeals form when submitting your appeal. View LifeWise appeal forms.

What’s next
We’re actively working to improve our intake quality and turnaround times. We’ll share an update once the Availity claim appeals feature is ready to launch.