Introducing Availity EDI Clearinghouse Plans: Base and Comprehensive

 

 

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Availity is making changes to its payer list, which affects providers and organizations that use Availity’s EDI Clearinghouse service. Your organization has been identified as one of the affected organizations and must select a new EDI Clearinghouse plan by the deadline listed in your emails.

This page provides information about the change and details on the new pricing structure. 

 

EDI Basics

Before we get into the details of the change, let’s clarify a few terms. Click the image below to view our EDI Clearinghouse infographic. If you’re confident in your understanding of EDI, feel free to scroll to the next section.

Availity - EDI Clearinghouse

  

What’s Changing and Why

Because of Availity’s network strength, many payers sponsor EDI transactions through Availity, while other payers do not. Until now, Availity has not passed any transaction fees on to the provider, but with increasing cost pressure we need to revise this model.

 

The good news is that you will continue to be able to submit to many payers for free. We are also offering a competitively priced option that provides access to all payers in Availity’s network, including government payers. 

 

The Availity Network: Your Connection to Payers Nationwide

Availity is the nation’s largest health information networks with connections to more than 2,000 payers nationwide, including government payers like Medicaid and Medicare. With Availity’s EDI Clearinghouse service, providers can easily reach more of their health plan partners. 

 

To explore our full list of payers, log into the Availity Portal and view the Payer List.

 

One Great Network; Two Flexible Plans

Availity’s new EDI Clearinghouse pricing plan features two options for connecting to our network. This pricing reflects extensive market research. But don’t just take our word for it. Do your own research and see how we compare.

 

EDI Clearinghouse Pricing

 

Select your EDI Clearinghouse Plan

You can select the EDI Clearinghouse Plan that best meets your needs, at any time, by accessing the plan selection tool and making your selection. To select a plan, log in to the Portal and click here

Your organization must select an EDI Clearinghouse by the deadline. If you do not, you will be automatically enrolled in the Base plan. Once that happens, any transactions routed to Comprehensive plan payers will fail, including any transaction sent to Medicaid or Medicare. Also, remittances from Comprehensive plan payers will no longer be available.   

 

*If the number of transactions exceeds the selected pricing tier, it is billed at the overage rate for the total number of transactions. Billing does not default to the next pricing tier. 

 
 

 
 
 
 
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