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Last Update Payer ID Payer Name Availity's Electronic Data Interchange (EDI) Health Plan Partners Government Payer* Claim Enroll Required Remit (835) NPI Option Professional Claim (837) 04111 MEDICARE PART A COLORADO x x 3 x 09101 MEDICARE PART A FLORIDA x x x 4* x 00320 MEDICARE PART A MINNESOTA x x 4* x 04211 MEDICARE PART A NEW MEXICO x x 3 x 04311 MEDICARE PART A OKLAHOMA x x 3 x 04411 MEDICARE PART A TEXAS x x 3 x 02102 MEDICARE PART B ALASKA x x x 4* x 03102 MEDICARE PART B ARIZONA x x x 4* x Institutional Claim (837) 18 of 124 Visit our web site: www.availity.com Eligibility & Benefits (270) Claim Status (276) Availity® Health Information Network Electronic Data Interchange (EDI) & Web Solutions Companion Guides Auth & Referral (278) Additional Information Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form: https://www.novitas-solutions.com/edi/enrollment/pdf/8292.pdf Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE INFORMATION: Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity. Availity does not prepare claims. Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC. Section F: REQUEST TYPE: Select Add to existing submitter ID: 1937018 Before submitting claims you must do the following: 1. Complete the EMC change of information form. FCSO requires each provider to complete this form in advance of any changes affecting the provider’s EDI connectivity to FSCO. The form is available at: http://medicare.fcso.com/EDI_Forms/. In Section A, under Type of Change being requested, select Add a Provider to an existing submitter number. In Section C, list P8467 for the submitter number. Submit the completed form to FCSO. If you do not submit the completed form to FCSO, Availity will not be able to send claims to FCSO on your behalf. You will receive an acknowledgement from FCSO once your form is processed. After you receive the acknowledgement, you can begin sending your Florida Medicare Part A claims. Please contact your practice management system vendor if you need assistance adding this Payer ID to your system. Note: These steps apply ONLY to Florida Medicare Part A (837I) and Part B (837P) Claims. This does not affect Eligibility and Benefits Inquiries (270/271), or how you currently receive your Electronic Remittance Advice (835) files or paper Remittance Advices from FCSO today. For questions concerning the forms, contact the Medicare EDI help desk 888.670.0940. Click this link and complete the required enrollment: https://www.noridianmedicare.com. Please use Availity’s Submitter ID of CH00033 on the enrollment form. After enrolling, your payer assigned submitted ID should go in loop 1000A NM109. For questions, call EDI Support Services at 800.967.7902. Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form: https://www.novitas-solutions.com/edi/enrollment/pdf/8292.pdf Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE INFORMATION: Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity. Availity does not prepare claims. Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC. Section F: REQUEST TYPE: Select Add to existing submitter ID: 1937020 Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form: https://www.novitas-solutions.com/edi/enrollment/pdf/8292.pdf Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE INFORMATION: Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity. Availity does not prepare claims. Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC. Section F: REQUEST TYPE: Select Add to existing submitter ID: 1937021 Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form: https://www.novitas-solutions.com/edi/enrollment/pdf/8292.pdf Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE INFORMATION: Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity. Availity does not prepare claims. Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC. Section F: REQUEST TYPE: Select Add to existing submitter ID: S00532 Visit this link and complete the required enrollment: https://noridian.totalonboarding.com/Account/Login?ReturnUrl=%2f a. Company Name – Availity LLC b. Trading Partner Id – CH00033 c. Do not select Availity LLC to ‘Manage Vendor’ account The Assigned Submitter ID must go in Loop 1000A, NM109. For questions, call EDI Support Services at 800.967.7902. Visit this link and complete the required enrollment: https://noridian.totalonboarding.com/Account/Login?ReturnUrl=%2f a. Company Name – Availity LLC b. Trading Partner Id – CH00033 c. Do not select Availity LLC to ‘Manage Vendor’ account The Assigned Submitter ID must go in Loop 1000A, NM109. For questions, call EDI Support Services at 800.967.7902.
Last Update Payer ID Payer Name Government Payer* Claim Enroll Required Remit (835) NPI Option Professional Claim (837) 04112 MEDICARE PART B COLORADO x x 3 x 09102 MEDICARE PART B FLORIDA x x x 4* x 02202 MEDICARE PART B IDAHO x x x 4* x 00952 MEDICARE PART B ILLINOIS x x x 4* x 08202 MEDICARE PART B MICHIGAN x x 4* x 00954 MEDICARE PART B MINNESOTA x x x 4* x 04212 MEDICARE PART B NEW MEXICO x x x 3 x Availity's Electronic Data Interchange (EDI) Health Plan Partners Institutional Claim (837) 19 of 124 Visit our web site: www.availity.com Eligibility & Benefits (270) Claim Status (276) Availity® Health Information Network Electronic Data Interchange (EDI) & Web Solutions Companion Guides Auth & Referral (278) Additional Information Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form: https://www.novitas-solutions.com/edi/enrollment/pdf/8292.pdf Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE INFORMATION: Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity. Availity does not prepare claims. Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC. Section F: REQUEST TYPE: Select Add to existing submitter ID – Enter Submitter ID JBS00532 Before submitting claims you must do the following: 1. Complete the EMC change of information form. FCSO requires each provider to complete this form in advance of any changes affecting the provider’s EDI connectivity to FSCO. The form is available at: http://medicare.fcso.com/EDI_Forms/. In Section A, under Type of Change being requested, select Add a Provider to an existing submitter number. In Section C, list P8467 for the submitter number. Submit the completed form to FCSO. If you do not submit the completed form to FCSO, Availity will not be able to send claims to FCSO on your behalf. You will receive an acknowledgement from FCSO once your form is processed. After you receive the acknowledgement, you can begin sending your Florida Medicare Part B claims. Please contact your practice management system vendor if you need assistance adding this Payer ID to your system. Note: These steps apply ONLY to Florida Medicare Part A (837I) and Part B (837P) Claims. This does not affect Eligibility and Benefits Inquiries (270/271), or how you currently receive your Electronic Remittance Advice (835) files or paper Remittance Advices from FCSO today. For questions concerning the forms, contact the Medicare EDI help desk 888.670.0940. Visit this link and complete the required enrollment: https://noridian.totalonboarding.com/Account/Login?ReturnUrl=%2f a. Company Name – Availity LLC b. Trading Partner Id – CH00033 c. Do not select Availity LLC to ‘Manage Vendor’ account The Assigned Submitter ID must go in Loop 1000A, NM109. For questions, call EDI Support Services at 800.967.7902. Contact 877-567-7261 to enroll in EDI. The required Clearinghouse information needed to complete the EDI enrollment: Name: Availity LLC Address: 10752 Deerwood Park Blvd. #110 City: Jacksonville State: FL Zip: 32256 Contact: Client Services Contact Email address: support@availity.com Contact Phone Number: 800-282-4548 WPS Submitter Number: 70000 Contact 877-567-7261 to enroll in EDI. The required Clearinghouse information needed to complete the EDI enrollment: Name: Availity LLC Address: 10752 Deerwood Park Blvd. #110 City: Jacksonville State: FL Zip: 32256 Contact: Client Services Contact Email address: support@availity.com Contact Phone Number: 800-282-4548 WPS Submitter Number: 70000 Contact 877-567-7261 to enroll in EDI. The required Clearinghouse information needed to complete the EDI enrollment: Name: Availity LLC Address: 10752 Deerwood Park Blvd. #110 City: Jacksonville State: FL Zip: 32256 Contact: Client Services Contact Email address: support@availity.com Contact Phone Number: 800-282-4548 WPS Submitter Number: 70000 Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form: https://www.novitas-solutions.com/edi/enrollment/pdf/8292.pdf Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE INFORMATION: Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity. Availity does not prepare claims. Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC. Section F: REQUEST TYPE: Select Add to existing submitter ID – Enter Submitter ID JBS00532
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