Health Plan Transactions
Connect with Multiple Health Plans
Availity® streamlines your daily health plan administrative functions with a single online connection to multiple insurance carriers. Instead of phoning, faxing, and mailing forms, you get instant and secure access to information and transactions you need every day.
Availity Benefits
- HIPAA compliant transactions with multiple health plans
- Seamless information exchange with billing systems
- Submit accurate information and avoid data entry errors with Availity edits
- Manage financial risk by accessing eligibility and benefits information within seconds
- Manage accounts receivable by checking claim status for processed claims
- Automate accounts receivable by receiving electronic remittance
- Minimize data entry by swiping magnetic strip-enabled member ID cards
- Submit accurate information and avoid data entry errors with Availity edits
Health Plans Supported
Electronic data interchange (EDI) transactions are supported by more than 1,000 health plans (pdf) nationwide. Online real-time transactions are supported by the following health plans. Other plans will be added on an ongoing basis. Currently, Aetna, CIGNA, and Humana are the only real-time health plans available nationwide.
- Aetna
- America’s Health Choice
- AvMed
- Blue Cross and Blue Shield of Arizona
- Blue Cross and Blue Shield of Florida
- Blue Cross and Blue Shield of Illinois
- Blue Cross and Blue Shield of New Mexico
- Blue Cross and Blue Shield of Oklahoma
- Blue Cross and Blue Shield of Texas
- All Blue Plans nationwide (through the local host plan)
- Capital Health Plan
- CarePlus
- CIGNA
- Citrus Healthcare
- Florida Hospital Healthcare System
- Great-West Healthcare
- Humana
- Leon Medical Center Health Plan
- Medicaid
- Medicare
- METCARE
- Physicians United Plan
- United Healthcare
- Vista Healthplan
- WellCare
*Medicare and Medicaid batch EDI claims submissions are available for Florida, Idaho, Illinois, New Mexico, Oklahoma, Oregon, Texas and Washington. Real-time Medicare and Medicaid transactions are currently only available in Florida.
Transactions Supported
Availity supports compliant usage of the following ASC X12 standard transactions online in real-time and via electronic data interchange (EDI), delivering capabilities beyond the basic HIPAA mandates:
- Eligibility and Benefits Inquiry: Retrieve eligibility and benefits information via multiple search criteria, including Patient ID and Date of Birth, Patient Name and Member ID, or Patient Name and Date of Birth.
- Claim/Encounter Submission:Submit clean claims and encounters with confidence.
- Remittance Advice*:Receive electronic remittance to reconcile accounts receivable.
- Claim Status Inquiry:Verify the status of submitted claims.
- Health Care Services Review:Submit authorizations and referrals.
- Health Care Services Inquiry: Inquire about existing authorizations and referrals.
*Electronic remittance advice (ERA) is available from several health plans. The ERAs, which are used for automated reconciliation of accounts receivable, support all claims, whether submitted electronically or via paper. Availity delivers the ERAs to the Availity ReceiveFiles EDI mailbox, where claim error and other EDI reports are delivered. The information provided in an ERA can be imported into most electronic billing systems, offering seamless data exchange.
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For More Information
We invite you to experience the Availity Health Information Network demonstration at your leisure. Using the demo does not require registration or login. You may also view and print our brochure (pdf).
Vendors that are interested in integrating with the Availity Health Information Network should access the Availity EDI Guidelines and fill out a Contact Us form.
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