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Contact our Trading Partner or Channel Partner team below:
1) First Name
2) Last Name
3) Email
4) Phone
5) Job Title
6) What is the name of your company?
Where is your company headquarters located?
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
8) I am a...
Developer looking to learn about API
Vendor looking to learn more about becoming a reseller of Availity solutions
9) Do you currently have an Availity account?
Yes
No
What is your Availity customer ID?
10) What is your average transaction estimate per month? (Including claims, authorizations, eligibility & benefits, etc.)
11) How will your system transmit information to Availity? (please select all that apply)
SFTP 837 835
HTTPS wxml wrapper 270 271 276 277 278
REST API - JSON
12) Which electronic transactions are being requested? (please select all that apply)
837 - Claims
835 - ERA
2701 Realtime SoapWS REST API
276 277 Claim status Realtime SoapWS REST API
278 Auth Referral Realtime SoapWS REST API
13) When would you like to start testing/go-live with a production account?
Within the next 3 weeks
Between 1-3 months
Between 4-7 months
More than 8 months
14) How does your organization operate and what are you looking for, specifically?
9) Which of these software types best describes your company?
EMR
Practice Management System
Billing Software
Ambulatory Software
Long-Term Care Software
Behavioral Health Software
Patient Portal
Dental Software
Other
Other software type
10) Are you able to generate ANSI 837 files?
Yes
No
11) How many providers do you work with currently?
12) Please include any other details that you think would be helpful for our conversation
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