Why Portal Access is Key to Billing Success

Access to payer portals is essential for every medical billing professional in Revenue Cycle Management (RCM). These portals provide direct visibility into payments, denials, and often allow appeals to be completed online. Having this access streamlines workflows, reduces manual follow-up, and saves both time and money. By reviewing claim status online, practices can stay ahead of denials, monitor payments more effectively, and ensure timely filing and appeals.

Challenges with the Traditional Appeals Process

Traditional manual methods for submitting appeals—via phone, mail, or fax—create significant bottlenecks due to being slow, confusing, and resource-intensive. These inefficiencies are compounded by:

• Excessive wait times when using the phone.
• Mail delays with no ability to track confirmation of receipt.
• Lack of visibility into the appeal status, as there is no tracking number or real-time update on whether the appeal is under review or has been denied.

Ultimately, these problems lead to delayed reimbursements, lost revenue, and considerable frustration for healthcare providers. Online portals offer a solution by helping payers and billing staff reduce delays, process appeals faster, improve follow-up efficiency, and increase overall visibility.

Payment Challenges

Without portal access, practices must rely on receiving electronic remittance advice (ERAs) and/or mailed explanations of benefits (EOBs), which can slow reconciliation and posting processes. This lack of real-time visibility also makes it difficult to identify missing payments or payer recoupments promptly. As a result, cash flow is disrupted, and month-end reporting becomes less accurate.

Denial Management Challenges

Traditional denial follow-up methods create inefficiencies that can lead to missed appeal deadlines and lost revenue. Limited access to claim-level details hinders the billing team’s ability to identify trends, root causes, and corrective actions. Portal access allows denials to be reviewed faster, reworked with supporting documentation, and resubmitted efficiently, helping reduce overall denial rates.

Why Payers Are Moving to Portal Claim Status Only

Given the drive to greater claim efficiency, we’re seeing more payers shift to offering claims status strictly through portals, for a few admittedly good reasons. 

Operational Efficiency 

Insurance companies are shifting to digital claim status tools (like Availity, NaviNet, or payer-specific portals) to reduce call volume and streamline communication. Phone inquiries require live staff, which increases administrative costs and delays.

Accuracy and Compliance

Online portals provide real-time claim information directly from the payer’s adjudication system, reducing the risk of misinformation or inconsistent updates that can occur over the phone.

Documentation and Transparency

Digital systems create auditable records of claim inquiries and actions—something not possible with phone-based communication and incredibly valuable for compliance and appeals tracking.

Standardization Across the Industry

As part of ongoing administrative simplification under HIPAA and federal initiatives, payers are moving toward fully electronic transactions, including eligibility, claim submission, status checks, and remittance advice.

Why Provider Billing Teams Need Portal Access

As payers transition away from phone-based support, portal access is now essential for efficient billing operations. Granting your billing team secure access ensures they can verify claim statuses, resolve issues quickly, and safeguard your revenue cycle—without adding administrative burden to your office staff. Here’s what your staff can do with the right access. 

Timely Revenue Recovery

Billing teams can check claim status in real time without waiting on hold or submitting phone inquiries, leading to faster identification and correction of issues that delay payment.

Fewer Denials and Rework

Quick visibility into claim status allows the billing team to address denials or missing information promptly, preventing claims from aging unnecessarily.

Improved Workflow Efficiency

Portal access enables the billing team to manage large claim volumes more effectively, improving productivity and ensuring that providers get paid sooner.

Portals transform denial management into a faster, more transparent, and efficient process—driving higher revenue recovery, reducing administrative burdens, and ensuring seamless patient care.

Key challenges in securing portal access

Providers and administrators can become frustrated by repeated requests for portal access or resets from multiple RCM Billing staff. It would be convenient if, once access is granted, no further action would ever be required. However, in reality, payer portals frequently require revalidation, credential resets, or ongoing admin updates, especially when:

• Payer systems change or merge.
  
• Password expirations or MFA(Multi Factor Authentication) resets occur.
  
• Dual-admin access is required for compliance or system design.
  

Why am I getting multiple access requests?

If you’re getting notifications for multiple access requests, there are a few potential reasons. Some payer portals automatically deactivate passwords or access following periods of inactivity. In some cases, system changes, like the Gainwell, Availity, or Change Healthcare transitions, for example, can reset or revoke previously established logins. Many of these companies have security policies that require revalidation when user or group details change (e.g., address, TIN, NPI). Or it’s possible that for a dual admin setup, both the RCM team and the member site admin are required to approve or maintain access.

Here’s what you need to know

Because we at WebPT are dealing with so many payers — and thus so many portals — we’ve learned a few things about how to better manage and use portals that we want to share to help you and other providers. Hopefully, these tips can help you make better use of portals from the start, rather than through trial and error.  

• Portal access is not permanent—some payers require reauthorization or periodic resets.
• Having a dual-admin setup allows WebPT RCM and the member to share responsibility for access and updates.
• These processes are in place to protect PHI and maintain compliance with payer security standards.
• Timely responses to access or reset requests help avoid claim delays and revenue impact.

Using platforms like Availity enables faster, more transparent, and efficient resolution of denied claims—ultimately improving revenue recovery, lowering administrative costs, and supporting continuity of patient care. As one of the most commonly used multi-payer platforms, it highlights both best practices and common pain points in portal access management. Additionally, allowing for digital appeals through Availity offers greater ease and simplicity compared to traditional processes. 

• Streamlined submissions: Billing teams can submit appeals directly through Availity for multiple health plans from one platform.
• Real-time visibility: You can track the status and outcomes of appeals without waiting for payer responses by phone or mail.
• Document uploads: Easily attach supporting documentation to strengthen appeal submissions.
• Reduced admin burden: Frees up staff to focus on patient care and proactive revenue management instead of paperwork.
• Improved communication: Direct digital exchange between providers and payers minimizes back-and-forth and ensures appeals reach the right place.

Tips and key points to remember

Allowing your Revenue Cycle Management (RCM) team access to submit appeals, track claim visibility, and attach supporting documentation streamlines the denial management process. This access reduces administrative paperwork, enhances communication, and ensures timely appeal submissions. So, we’ll leave you with a few things to keep at the top of your mind.

• Accounts are being approved for user access; however, your Billing Representative requires Portal Manager admin access to approve other Billing representatives to work on your AR.
• Please ensure your Portal Manager has access to all plans within payer spaces and remittance, as this is where appeals and missing EOBs are located.
• Many insurance plans are moving their claims and payments to Availity.  Please ensure you sign up in Availity for those payers in the payer spaces, etc., so your AR team is fully equipped to work on AR and denials promptly. 
• This resource on the multi-payer provider portal from Availity is incredibly useful, but you can also reach out to your RCM Team for additional questions.

As the healthcare industry continues to digitize communication and payment processes, maintaining proactive portal access management is more critical than ever. By partnering closely with your billing team, ensuring dual-admin access, and keeping credentials current across platforms like Availity, practices can minimize disruptions, safeguard revenue, and improve claim turnaround times. Investing a little time in portal access and reset education today helps ensure a smoother, faster, and more transparent revenue cycle tomorrow.