EDI Connection Guide - Availity

Availity Gateway and Availity Essentials

EDI Connection Guide

Table of contents

Welcome....................................................................................................................................................... 3

Modes for submitting transactions............................................................................................................... 4

Choose how to submit transactions to Availity.........................................................................................4

Submit transaction files through FTP....................................................................................................... 5

Submit transaction files through Availity Essentials................................................................................. 6

Submit transactions through manual data entry in Availity Essentials..................................................... 7

Register your business................................................................................................................................. 8

FTP setup..................................................................................................................................................... 9

Create your Availity FTP account.............................................................................................................9

Configure your FTP client.......................................................................................................................10

Set up your EDI reporting preferences...................................................................................................... 11

Enroll for transactions.................................................................................................................................12

Set up your Availity Essentials users.........................................................................................................13

Submit Transactions................................................................................................................................... 14

Submit transaction files through FTP or manual upload through Availity Essentials..............................14

Submit transactions through manual data entry in Availity Essentials................................................... 15

Additional Information................................................................................................................................. 16

Key resources......................................................................................................................................... 16

Answers to FAQs.................................................................................................................................... 17

Support tools........................................................................................................................................... 18

Availity Gateway and Availity Essentials: EDI Connection Guide | Updated 2022-09-16

? Availity, LLC, all rights reserved | Confidential and proprietary.

Welcome

Welcome to Availity! This guide includes information to get you started with submitting Electronic Data

Interchange (EDI) transactions to Availity, from registration to on-going support. We welcome your

feedback. Please let us know what we can do to improve your experience and our documentation.

Availity is making healthcare better

Availity is an industry-leading, HITRUST-certified health care information technology company that

serves an extensive network of health plans, providers, and technology partners nationwide through a

suite of dynamic products built on a powerful, intelligent platform. We integrate and manage the clinical,

administrative, and financial data our customers need to fuel real-time coordination and collaboration

amongst providers, health plans, and patients in a growing value-based care environment.

Availity Gateway and Availity Essentials: EDI Connection Guide | Updated 2022-09-16 | Page 3 of 18

? Availity, LLC, all rights reserved | Confidential and proprietary.

Modes for submitting transactions

Choose how to submit transactions to Availity

Availity provides a variety of modes for submitting your transactions. You can choose to always submit

your transactions through a single mode, such as through File Transfer Protocol (FTP), or you can

submit some transactions through one mode and other transactions through a different mode. This guide

describes the setup process for the following modes:

?

Submit transaction files through FTP - If you work with a practice management system, health

information system, or other automated system that supports an FTP connection, you can securely

upload batch files of X12 EDI transactions to the Availity FTP site where they are automatically picked

up by Availity and submitted to the appropriate health plans.

?

Submit transaction files through Availity Essentials - If you have batch files of X12 EDI

transactions that you need to process and you don't have access to an FTP connection, you can

manually upload the batch files through Availity Essentials.

?

Submit transactions through manual data entry in Availity Essentials - Availity Essentials makes

it easy to submit transactions, such as eligibility and benefits inquiries or claims, by entering data into

our user-friendly Web forms.

Important: Submitting transactions through manual data entry is provided at no charge but does not

include government payers, such as Medicare or Medicaid, or any payers that require a contract. To

determine whether any of the payers that you submit to require a contract, see the Availity payer list.

Note: If you want to submit real-time transactions through Availity's Simple Object Access Protocol

(SOAP) Web service, you'll need to contact Availity Client Services to request a setup. See the Availity

payer list for payers that support real-time (SOAP) transactions.

Availity Gateway and Availity Essentials: EDI Connection Guide | Updated 2022-09-16 | Page 4 of 18

? Availity, LLC, all rights reserved | Confidential and proprietary.

Submit transaction files through FTP

If you'll be submitting X12 EDI files through the Availity FTP site, you'll follow the setup process in the

figure below. The lighter-colored tasks are optional.

Get started by registering your business with Availity. If your business is already registered, then you're

ready to create your FTP account.

Note: To complete the post-registration setup steps, you'll need an Availity Essentials account. If you

don't have an Availity Essentials account, contact the Availity administrator for your business and ask

them to create an account for you that includes the EDI Management role.

Figure 1: Setup tasks for submitting files through FTP

Availity Gateway and Availity Essentials: EDI Connection Guide | Updated 2022-09-16 | Page 5 of 18

? Availity, LLC, all rights reserved | Confidential and proprietary.

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