Health Plan/Payer List Availity Clearinghouse and Web Portal

Health Plan/Payer List Availity Clearinghouse and Web Portal

Updated 10/07/2014

Availity P.O. Box 550857 Jacksonville, FL 32255-0857

Table of Contents

Health Plan/Payer List Availity Clearinghouse and Web Portal

Navigating the EDI Clearinghouse Health Plan Partners Section.............................................................................3 Availity's NPI Options....................................................................................................................................4 Availity's Electronic Data Interchange (EDI) Health Plans Partners....................................................................5 ? 32 Availity's Electronic Remittance Advice (ERA) Health Plan Partners................................................................33 - 49 Availity's Business to Business (B2B) Health Plan Partners.................................................................................50 Availity's Web Portal Health Plan Partners.................................................................................................51 ? 54 Workers' Compensation Payer List.........................................................................................................55 - 138

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Health Plan/Payer List Availity Clearinghouse and Web Portal

Navigating the EDI Clearinghouse Health Plan Partners Section

Claim Enrollment Required: Denotes payers that require enrollment for EDI claims submission (837P/I). See EDI Requirements for enrollment details.

Government Payer: Denotes Government payers. May not be a direct connection to the government entity.

Remit (835): Electronic remittance advice sent by payers to communicate adjudication results and payment information for submitted claims. Receiving remits generally requires additional enrollment. Please enroll with Availity first. Please see the Electronic Remittance Advice (ERA) Health Plan Partners section of the list for registration details.

NPI Option: The NPI is a unique identification number for covered health care providers. Availity is making every effort to confirm and communicate the status of our connected payers. For a detailed explanation of our NPI options please see page 4 of this document.

(EDI) Electronic Data Interchange: Customers create batch transactions in their own practice management system (PMS) or hospital information system (HIS) and upload them to Availity. This functionality can be transparent to the end user if their system vendor offers a seamless solution. Availity also offers end users the ability to log onto the portal to upload batches directly. A list of vendor partners is available on the Availity web site.

(B2B) Business to Business: Customers submit transactions in real-time or near real-time using their own practice management system (PMS) or hospital information system (HIS), often using the vendor's user interface. A list of vendors that support this level of integration is available on the Availity web site. Please see Availity's B2B specification document for additional information.

Premium ($): The "$" in the Premium column indicates that the payer requires enrollment in Availity Advanced Clearinghouse if the provider is based in Texas. Please click the link for more information:

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Availity's NPI Options

Option 1 Option 2

Legacy ID Required Dual ID

NPI allowed Legacy identifier required

Allows all of the following scenarios: NPI only Legacy identifier only NPI and Legacy identifiers

Option 3 Option 4

NPI per Mandate

NPI required as Primary Identifier. Tax ID required as a secondary identifier on claims in 2010AA or 2010AB. Only specific non-Legacy qualifiers allowed as secondary identifiers in certain

provider loops.

NPI per Mandate. Legacy ID also allowed.

4 = Option 3 plus: Any other secondary identifiers as allowed in the Implementation Guide will also be

accepted.

4* = Option 3 plus: Tax IDs (EI, SY, TJ) as allowed in the Implementation Guide will also be accepted

as secondary identifiers.

4# = Option 3 plus: Location Numbers (LU) as allowed in the Implementation Guide will also be

accepted as secondary identifiers.

*A legacy identifier is any identifier that payers used to identify a provider as a health care provider before the NPI mandate. Legacy identifiers include OSCAR, NSC, PINs, UPINs, Blue Cross provider numbers, and other payer-designated identifiers.

(+) Indicates the payer has requested a front-end taxonomy code edit.

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Availity's Electronic Data Interchange (EDI) Health Plan Partners

Government Payer* Claim Enroll Required

Remit (835) NPI Option

Premium Payer ID

Payer Name

Professional Claim (837)

Institutional Claim (837)

Eligibility & Benefits (270)

Claim Status (276)

Auth & Referral

(278)

Additional Information

13162 93044 48185 68069 AHS01 64071 37118 87815 72467 38254 75678 22384 59141 38265 37278 58202 51909 35209 77070 59374 25133 95340 65093 36320 65093

1199 NATIONAL BENEFIT FUND A & I BENEFIT PLAN ADMINISTRATORS ABC HEALTH PLAN ABSOLUTE TOTAL CARE ACCESS ADMINISTRATOR ACCLAIM ACMG ACORDIA NATIONAL ACS CONSULTING SERVICES, INC ACTIVA BENEFIT SERVICES, LLC ACTIVE CARE (UCS) ADMINISTRATIVE CONCEPTS, INC ADMINISTRATIVE SERVICES ADMINISTRATIVE SYSTEMS RESEARCH CORPORATION - ASR ADMINONE ADVANCED DATA SOLUTIONS, INC ADVANCED PHYSICIAN ASSN. (CHICAGO) ADVANTAGE HEALTH SOLUTION ADVANTAGE PREFERRED PLUS ADVANTICA ADVANTRA/HLTH AMERICA INC ADVENTIST HEALTH SYSTEM WEST - ROSEVILLE, CA ADVOCATE HEALTH PARTNERS ADVOCATE MEDICAL GROUP ADVOCATE PHYSICIAN PARTNERS

$

26337

AETNA - ILLINOIS MEDICAID

3

x

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2

x

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2

x

x

x

3

x

x

3

x

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2

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2

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3

x

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2

x

2

x

x

2

x

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2

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2

x

x

2

x

x

2

x

x

2

x

x

2

x

x

2

x

x

2

x

x

2

x

x

2

x

x

2

x

x

x

4

x

x

x

4

x

x

x

4

x

x

2

x

x

$

60054

AETNA AFFORDABLE HEALTH CHOICES (SM) - SRC

2

x

x

$

23225

AETNA BETTER HEALTH CONNECTICUT MEDICAID

50023

AETNA BETTER HEALTH OF OHIO

$

60054

AETNA INSURANCE COMPANY

2

x

x

2

x

x

x

2

x

x

$

38692

AETNA TX MEDICAID & CHIP

x

2

x

x

13334

AFFINITY HEALTH PLAN

2

x

x

13346

AFTRA HEALTH FUND

2

x

x

64158

AGENCY SERVICES, INC.

2

x

x

95327

ALAMEDA ALLIANCE FOR HEALTH

x

4

x

91136

ALASKA CHILDREN'S SERVICES, INC.

2

x

x

92600

ALASKA ELECTRICAL HEALTH & WELFARE FUND

2

x

x

91136

ALASKA LABORERS CONSTRUCTION INDUSTRY TRUST

2

x

x

91136

ALASKA PIPE TRADERS LOCAL 375

2

x

x

91136

ALASKA UNITED FOOD & COMMERCIAL WORKERS HEALTH & WELFARE TRUST

2

x

x

13550

ALICARE

2

x

x

PRINT

ALL HEALTH PLAN PRINT (PRINT TO PAPER)

x

2

x

x

MRIPA 81040 ADSL1 88461 52149 58234 94177 37308 75261 A0701 25133 AMAIA 13550 68069 68069 68069

ALLCARE HEALTH PLAN ALLEGIANCE BENEFIT PLAN ALLIANCE - ALPHA CARE GOLD ALLIANCE HEALTHPLANS OF WISCONSIN ALLIANCE PPO, INC. ALLIANT HEALTH PLANS (GEORGIA) ALLIED ADMINISTRATORS (S.F., CA) ALLIED BENEFITS SYSTEMS ALPHA DATA SYSTEMS ALTA BATES MEDICAL GROUP ALTA HEALTH STRATEGIES AMA INSURANCE AGENCY AMALGAMATED LIFE AMBETTER FROM BUCKEYE COMMUNITY HEALTH PLAN AMBETTER FROM COORDINATED CARE AMBETTER FROM CELTICARE HEALTH PLAN

x

3

x

x

4

x

x

2

x

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2

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2

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2

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2

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4

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4

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2

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4

x

x

payer ID 68055 may also be used

formerly Advocate Health Centers EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@ for further details. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@ for further details. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@ for further details. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@ for further details. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@ for further details. When submitting to this payer ID please ensure the following: The claim is for a Medicaid, Child Health Plus, or Family Health Plus member and the subscriber ID is as printed on Member's ID Card

Please contact Anet Quiambao at 510.747.6153 to join Alameda Alliance's EDI network

To enroll for All Health Plan Print (Print To Paper), please complete and submit the APP Submitter Information and Enrollment Packet. Please note that claims cannot be converted to paper for payers with the state code of SC or MN. APP Submitter Information and Enrollment Packet Effective 8/1/2012, formerly known as Mid Rogue Oregon Health Plan

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