Last Updated: April 1, 2026
This Terms of Use Agreement (“Agreement”) governs your use of the availity.com website and the services made available through the site (together the “Site”). The Site is operated by Availity, LLC (“Availity,” “we,” “our,” or “us”). Please read this Agreement carefully (and the Availity Privacy Policy) before using any part of the Site. By accessing and using the Site, you are signifying your acceptance of this Agreement and the Privacy Policy. If you decide to do more than review the publicly available contents of our Site, such as register or make use of the Site services, you will be asked to agree to additional terms and conditions. In the event of a conflict between those additional terms and conditions and this Agreement, the terms of the additional terms and conditions shall govern. If you use this Site on behalf of an organization, such as a health provider, references in this Agreement to “you” and “your” are intended to be references to you individually and to your organization, both of which are to be bound.
No Medical Advice
Although Availity is dedicated to servicing the health care industry, Availity is not authorized or licensed to provide, and does not engage in providing, medical advice. Nothing in the Site is intended to be construed as the provision by Availity of medical advice.
Acceptable Use
You may not use the Site for anything other than a lawful and legitimate purpose, and not in any way that would violate this Agreement or the law. Regardless of the location from where the Site is used or accessed, you agree to comply with all applicable laws, regulations, statutes, and ordinances in connection with the use of the Site. Examples of prohibited uses include, without limitation: (a) violation of any person’s or entity’s proprietary, publicity, privacy, or other right; (b) use of the information obtained through or from the Site to commit fraud; (c) misuse or disclosure of a person’s or entity’s confidential or proprietary information; (d) downloading or otherwise exporting programs or content from the Site in violation of United States export laws; (e) transmission, storage, or knowing receipt of any obscene or pornographic material or engaging in any misleading, tortious, defamatory, libelous, or offensive activity; or (f) disruption of the Site or attempts to purposefully disrupt the Site, through use of methods such as viruses, Trojan horses, worms, time bombs, denial of service attacks, flooding, or spamming. In addition, to the extent applicable, you agree not to use, access, combine, or disclose the information available on the Site in such a way that would violate the Health Insurance Portability and Accountability Act (“HIPAA”), its regulations or other applicable law.
Reporting Fraudulent Activity or Inappropriate Site Usage or Behavior
If you become aware of or suspect fraudulent or unlawful activity or any other activity that threatens the security of the Site, its content, operations, or any part thereof, or appears to be a misuse or unauthorized access to any confidential or medical information, you are obligated to immediately report the activity to Availity. We ask that you also report to us any activity on or regarding the Site that comes to your attention that is inappropriate, abusive, or otherwise problematic. Availity reserves the right but not the obligation to pursue actions against any such wrongdoers. To report any of the foregoing problematic or potentially problematic activity, please see the Contact Us section below.
Reporting Certain Abuses to Law Enforcement Authorities; Legal Process and Notifications
Availity reserves the right to report to local, national, or international law enforcement agencies abuse and violations of this Agreement, including, without limitation, those that may compromise the safety of you or users of the Site or the subjects of information sent through the Site. Nothing in this Agreement shall be construed to prohibit or restrict Availity from complying with any applicable laws, law enforcement requests, subpoenas, legal requirements, and legal reporting obligations relating to your or another user’s use of the Site, or use of information or user information.
Disclaimers
You expressly understand and agree that all information and services contained on, used through, or obtained from the Site are provided “as is” and on an “as available” basis. Availity, its licensors, and its information and service providers do not warrant that the information and services contained on, used through or obtained from the Site are accurate, complete, free from bugs, defects, harmful components, or errors, or that sent information will reach the intended destination or reach it in the form intended, or that the system will be accessible without interruption, or that any such defects, harmful components, errors or miss-deliveries will be corrected or removed.
Availity makes no, and hereby expressly disclaims all, warranties, express or implied, including, without limitation, as to the merchantability, fitness for a particular use or purpose, non-infringement, title, or any other warranty, condition, guaranty, or representation, whether oral, written, or in electronic form, with respect to the content or operation of the Site, including but not limited to, regarding the quality, accuracy, usefulness, timeliness, availability, operation, or completeness of any information or services provided on or made available through the Site. Additional disclaimers may appear on the site and are incorporated herein by reference.
Availity is not responsible for any breach of security or for the unauthorized use by others of your information.
You acknowledge that Availity does not endorse or act in a representative capacity and is not responsible or liable for any affiliate site, any Site user, or any third party.
No Third-Party Beneficiary
Nothing in this Agreement shall be construed to establish a basis for claims against Availity (its officers, directors, or employees) by third parties asserting status as third-party beneficiaries.
Down Time
Availity takes commercially reasonable measures so that the Site is available without significant interruption, except for scheduled down time needed to help maintain effective operation of the Site. However, difficulties with hardware, software, and equipment as well as services supplied by others may result in service interruptions.
Links
From time to time, the Site may contain links to other sites. Such links are for your information and convenience only and the fact that they are linked to or from the Site does not mean that such sites or their contents, services, or goods, are endorsed by Availity. When you visit such sites, please review their terms of use and privacy policies before you use them. You may not insert a link to the Site without Availity’s prior written permission.
Denial of Access and Termination
Availity may suspend, deny, and terminate your access to the Site at any time. Availity reserves the right to access, read, copy, delete and disclose information on Availity’s systems and equipment. Availity reserves the right to inspect all files and information stored on or transmitted through Availity equipment. Suspension, denial, or termination of your use of the Site does not affect or terminate your obligations to Availity.
Fees and Charges
Availity may charge for some, or all of the services provided on or through the Site. Such charges will be set forth in a separate agreement between you and Availity, in this Agreement, on the Site itself, or on materials provided with the service, and Availity may change such charges on notice to you.
Intellectual Property
Availity and its licensors and its information providers retain all intellectual property rights with respect to the Site. All Site content included or available on the Site, including, but not limited to, trade names, trademarks, service marks, text, graphics, interfaces, code, information, databases, technology (other than content or information sent to and from Site users) (collectively, the “Content”), and the selection and arrangement thereof, are the sole and exclusive property of Availity, or its licensors or information providers.
Indemnification
To the maximum extent allowed by applicable law, you agree to indemnify and hold harmless (and with respect to third party claims defend upon Availity’s request), Availity, its affiliates, and licensors and information providers, from and against all claims, suits, proceedings, losses, liabilities, and expenses, including without limitation, attorneys’ fees in connection with a third party claim, whether the claim or harm sounds in tort, contract, or otherwise, which arise out of, are a result of, or relate to your breach of any obligation, provision, acknowledgement, representation or warranty in this Agreement, your use of the Site or Site or any information sent, accessed, viewed, or received through the Site, your use of Content, and/or your activity in relation to the Site.
Electronic Communications
By using the Site, you are consenting to receive communications from Availity electronically and agreeing that Availity may communicate with you via e-mail, by posting notices on this Site, and, if Availity wishes, by regular means of communication, including for example, postal mail. You agree that all agreements, disclosures, notices, and other communications that Availity provides to you electronically satisfy any legal requirement that such communication be in writing.
Additional Terms
From time to time, the Site may contain additional terms and conditions (the “Additional Terms”) governing your use of the Site or components thereof, which Additional Terms are hereby incorporated by reference. You agree to comply with any such Additional Terms as part of this Agreement.
General
This Agreement shall, for all purposes, be construed, governed by, and enforced solely and exclusively in accordance with the laws of the State of Florida, USA, without giving effect to its conflict of law provisions or your actual state of residence or domicile. You hereby agree that the courts located in Jacksonville, Florida, USA, will constitute the sole and exclusive forum for the resolution of all disputes arising out of or in connection with this Agreement and you hereby irrevocably consent to the personal jurisdiction and venue of such courts and irrevocably waive any objections thereto. Any judgments obtained by such courts may be entered and enforced against you in any jurisdiction where you or your assets are located. You hereby waive any right to couple a claim with the claim(s) of others against Availity. Any legal action concerning this Agreement, or the Site must be brought by you within one (1) year after the claim or cause of action arises. If any provision of this Agreement is held to be invalid or unenforceable such provision shall be struck, and the remaining provisions shall be enforced. Availity’s failure to act with respect to a breach by you or others does not waive its right to act with respect to subsequent and/or similar breaches.
Health Insurance Claim Form Terms
Please note: The information provided here is intended to be accurate and up-to-date; however, in the event of any discrepancies between these terms and the official CMS.gov website, the CMS.gov site shall be considered the authoritative source and will govern. Users are encouraged to consult CMS.gov for the most current information.
CMS.GOV
NOTICE: Any person who knowingly files a statement of claim containing any misrepresentation or any false, incomplete or misleading information may be guilty of a criminal act punishable under law and may be subject to civil penalties.
REFERS TO GOVERNMENT PROGRAMS ONLY
MEDICARE AND TRICARE PAYMENTS: A patient’s signature requests that payment be made and authorizes release of any information necessary to process the claim and certifies that the information provided in Blocks 1 through 12 is true, accurate and complete. In the case of a Medicare claim, the patient’s signature authorizes any entity to release to Medicare medical and nonmedical information and whether the person has employer group health insurance, liability, no-fault, worker’s compensation or other insurance which is responsible to pay for the services for which the Medicare claim is made. See 42 CFR 411.24(a). If item 9 is completed, the patient’s signature authorizes release of the information to the health plan or agency shown. In Medicare assigned or TRICARE participation cases, the physician agrees to accept the charge determination of the Medicare carrier or TRICARE fiscal intermediary as the full charge and the patient is responsible only for the deductible, coinsurance and non-covered services. Coinsurance and the deductible are based upon the charge determination of the Medicare carrier or TRICARE fiscal intermediary if this is less than the charge submitted. TRICARE is not a health insurance program but makes payment for health benefits provided through certain affiliations with the Uniformed Services. Information on the patient’s sponsor should be provided in those items captioned in “Insured”; i.e., items 1 a, 4, 6, 7, 9, and 11.
BLACK LUNG AND FECA CLAIMS
The provider agrees to accept the amount paid by the Government as payment in full. See Black Lung and FECA instructions regarding required procedure and diagnosis coding systems.
SIGNATURE OF PHYSICIAN OR SUPPLIER (MEDICARE, TRICARE, FECA AND BLACK LUNG)
In submitting this claim for payment from federal funds, I certify that: 1) the information on this form is true, accurate and complete; 2) I have familiarized myself with all applicable laws, regulations, and program instructions, which are available from the Medicare contractor; 3) I have provided or will provide sufficient information required to allow the government to make an informed eligibility and payment decision; 4) this claim, whether submitted by me or on my behalf by my designated billing company, complies with all applicable Medicare and/or Medicaid laws, regulations, and program instructions for payment including but not limited to the Federal anti-kickback statute and Physician Self-Referral law (commonly known as Stark law); 5) the services on this form were medically necessary and personally furnished by me or were furnished incident to my professional service by my employee under my direct supervision, except as otherwise expressly permitted by Medicare or TRICARE; 6) for each service rendered incident to my professional service, the identity (legal name and NPI, license#, or SSN) of the primary individual rendering each service is reported in the designated section. For services to be considered “incident to” a physician’s professional services, 1) they must be rendered under the physician’s direct supervision by his/her employee, 2) they must be an integral, although incidental part of a covered physician service, 3) they must be of kinds commonly furnished in physician’s offices, and 4) the services of non-physicians must be included on the physician’s bills.
For TRICARE claims, I further certify that I (or any employee) who rendered services am not an active duty member of the Uniformed Services or a civilian employee of the United States Government or a contract employee of the United States Government, either civilian or military (refer to 5 USC 5536). For Black-Lung claims, I further certify that the services performed were for a Black Lung-related disorder.
No Part B Medicare benefits may be paid unless this form is received as required by existing law and regulations (42 CFR 424.32).
NOTICE: Any one who misrepresents or falsifies essential information to receive payment from Federal funds requested by this form may upon conviction be subject to fine and imprisonment under applicable Federal laws.
NOTICE TO PATIENT ABOUT THE COLLECTION AND USE OF MEDICARE, TRICARE, FECA, AND BLACK LUNG INFORMATION (PRIVACY ACT STATEMENT)
We are authorized by CMS, TRICARE and OWCP to ask you for information needed in the administration of the Medicare, TRICARE, FECA, and Black Lung programs. Authority to collect information is in section 205(a), 1862, 1872 and 1874 of the Social Security Act as amended, 42 CFR 411.24(a) and 424.5(a) (6), and 44 USC 3101 ;41 CFR 101 et seq and 10 USC 1079 and 1086; 5 USC 8101 et seq; and 30 USC 901 et seq; 38 USC 613; E.O. 9397.
The information we obtain to complete claims under these programs is used to identify you and to determine your eligibility. It is also used to decide if the services and supplies you received are covered by these programs and to insure that proper payment is made.
The information may also be given to other providers of services, carriers, intermediaries, medical review boards, health plans, and other organizations or Federal agencies, for the effective administration of Federal provisions that require other third parties payers to pay primary to Federal program, and as otherwise necessary to administer these programs. For example, it may be necessary to disclose information about the benefits you have used to a hospital or doctor. Additional disclosures are made through routine uses for information contained in systems of records.
FOR MEDICARE CLAIMS: See the notice modifying system No. 09-70-0501, titled, ‘Carrier Medicare Claims Record,’ published in the Federal Register, Vol. 55 No. 177, page 37549, Wed. Sept. 12, 1990, or as updated and republished.
FOR OWCP CLAIMS: Department of Labor, Privacy Act of 1974, “Republication of Notice of Systems of Records,” Federal Register Vol. 55 No. 40, Wed Feb. 28, 1990, See ESA-5, ESA-6, ESA-12, ESA-13, ESA-30, or as updated and republished.
FOR TRICARE CLAIMS: PRINCIPLE PURPOSE(S): To evaluate eligibility for medical care provided by civilian sources and to issue payment upon establishment of eligibility and determination that the services/supplies received are authorized by law.
ROUTINE USE(S): Information from claims and related documents may be given to the Dept. of Veterans Affairs, the Dept. of Health and Human Services and/or the Dept. of Transportation consistent with their statutory administrative responsibilities under TRICARE/CHAMPVA; to the Dept. of Justice for representation of the Secretary of Defense in civil actions; to the Internal Revenue Service, private collection agencies, and consumer reporting agencies in connection with recoupment claims; and to Congressional Offices in response to inquiries made at the request of the person to whom a record pertains. Appropriate disclosures may be made to other federal, state, local, foreign government agencies, private business entities, and individual providers of care, on matters relating to entitlement, claims adjudication, fraud, program abuse, utilization review, quality assurance, peer review, program integrity, third-party liability, coordination of benefits, and civil and criminal litigation related to the operation of TRICARE.
DISCLOSURES: Voluntary; however, failure to provide information will result in delay in payment or may result in denial of claim. With the one exception discussed below, there are no penalties under these programs for refusing to supply information. However, failure to furnish information regarding the medical services rendered or the amount charged would prevent payment of claims under these programs. Failure to furnish any other information, such as name or claim number, would delay payment of the claim. Failure to provide medical information under FECA could be deemed an obstruction.
It is mandatory that you tell us if you know that another party is responsible for paying for your treatment. Section 1128B of the Social Security Act and 31 USC 3801-3812 provide penalties for withholding this information.
You should be aware that P.L. 100-503, the “Computer Matching and Privacy Protection Act of 1988”, permits the government to verify information by way of computer matches.
MEDICAID PAYMENTS (PROVIDER CERTIFICATION)
I hereby agree to keep such records as are necessary to disclose fully the extent of services provided to individuals under the State’s Title XIX plan and to furnish information regarding any payments claimed for providing such services as the State Agency or Dept. of Health and Human Services may request.
I further agree to accept, as payment in full, the amount paid by the Medicaid program for those claims submitted for payment under that program, with the exception of authorized deductible, coinsurance, co-payment or similar cost-sharing charge.
SIGNATURE OF PHYSICIAN (OR SUPPLIER): I certify that the services listed above were medically indicated and necessary to the health of this patient and were personally furnished by me or my employee under my personal direction.
NOTICE: This is to certify that the foregoing information is true, accurate and complete. I understand that payment and satisfaction of this claim will be from Federal and State funds, and that any false claims, statements, or documents, or concealment of a material fact, may be prosecuted under applicable Federal or State laws.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid 0MB control number. The valid 0MB control number for this information collection is 0938-1197. The time required to complete this information collection is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. This address is for comments and/or suggestions only. DO NOT MAIL COMPLETED CLAIM FORMS TO THIS ADDRESS.
Changes
Availity may change the Site, its appearance, content, services, or information, at any time. Availity may change this Agreement from time to time as well. With respect to changes in the Agreement, check the Site periodically for any such changes. In addition, the effective date of the modified Agreement shall be set forth at the beginning of this Agreement. If you do not want to be bound by the modified Agreement or Additional Terms in your use of the Site, you should not continue to access or use the Site or use the services made available to you because you agreed to the Additional Terms. Your continued use of the Site following the posting of changes to the Agreement will constitute your acceptance of the modified Agreement. Your continued use of the services subject to the Additional Terms following the posting of changes to such Additional Terms, will constitute your acceptance of the modified Additional Terms.
Contact Us
If you have any questions about the Privacy Policy, this Agreement, or our Site and its operations, please contact us at [email protected] or via mail at:
Availity, LLC
Compliance & Privacy Program
5555 Gate Parkway, Ste 110
Jacksonville, FL 32256
