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Last Update Payer ID Payer Name Government Payer* Claim Enroll Required Remit (835) NPI Option Professional Claim (837) 04312 MEDICARE PART B OKLAHOMA x x x 3 x 02302 MEDICARE PART B OREGON x x x 4* x 04412 MEDICARE PART B TEXAS x x x 3 x 11302 MEDICARE PART B VIRGINIA x x 4* x 02402 MEDICARE PART B WASHINGTON x x x 4* x 00951 MEDICARE PART B WISCONSIN x x 3 x 00882 MEDICARE RAILROAD x x x 4* x Availity's Electronic Data Interchange (EDI) Health Plan Partners HDM04 MEDICO INSURANCE COMPANY 4 x x Institutional Claim (837) 20 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 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. 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 Click this link and complete the required enrollment: http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%2011%20Part% 20B~EDI~Enrollment~89BLL31745?open&navmenu=EDI||||InformationInformation Information necessary to complete the EDI Provider Information form: Section 2 - EDI Software Vendor Data, enter ‘Proprietary’. Section 3 - EDI Billing Service/Clearinghouse Data, enter Company Name: Availity L.L.C., Primary Contact: Availity Client Services, Phone: 1-800-282-4548, Submitter ID: S00532 For questions, call Palmetto GBA Technology Support Desk at 866.749.4301. Please note - Availity is not listed on the Palmetto GBA Part B Approved 5010 Errata Vendors list because Availity is not a software vendor. Availity is a clearinghouse who provides exemplary electronic service to the provider community. Palmetto GBA has granted Availity production approval for 5010 transactions. Providers using Availity to send claims to Palmetto GBA are not required to test. 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 Visit this link and complete the required enrollment: http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Railroad%20Medicare~EDI~ Enrollment~7GM24F7631?open Information necessary to complete the form: Submitter ID - S00532, ERN Receiver ID - ER0073, Submitter Name – Availity LLC, Owner Name – Lloyd Beesing, Contact Person - Client Services, Phone - 800-282-4548, Fax - 904-470-4773, Address – P.O. Box 550857, Jacksonville, FL 32255-0857, email - support@availity.com, Response Format – File, Mode: Connect – Direct, Data Compression - PKZIP. For questions concerning the forms contact the EDI help desk 866.749.4301.
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) Institutional Claim (837) Eligibility & Benefits (270) Claim Status (276) Availity® Health Information Network Electronic Data Interchange (EDI) & Web Solutions Companion Guides Auth & Referral (278) Additional Information 13123 MEDIGOLD PPO 2 x x 412MP MEDPARTNERS ADMIN SERVICES 2 x x 35205 MEDPARTNERS ADMIN SERVICES (IN) 2 x x 62160 MEDSOLUTIONS, INC. 2 x x 00243 MEDSTAR FAMILY CHOICE 3 x 74227 MEGA LIFE & HEALTH INS. (STUDENT INSURANCE) x 2 x x MCA11 MEMORIAL CLINICAL ASSOCIATES x 4 x x For 835, 270 and 276 transactions please use Payer ID: HPN11 MHHNP MEMORIAL HERMANN HEALTH NETWORK 4* x x 59064 MEMORIAL INTEGRATED HEALTHCARE 2 x x 74289 MENTAL HEALTH NETWORK (MHNET) 2 x x 86052 MERCY CARE PLAN 2 x x 22326 MERCY HEALTH PLAN OF NJ x 2 x x Medicaid managed care. For EDI support, please e-mail edi.horizonnjhealth@kmhp.com; formerly Horizon Mercy Health Plan MER11 MERCY HEALTH PLANS 2 x x 13189 MERIDIAN HEALTH PLAN OF ILLINOIS 4 x x 14145 MERIDIAN HEALTH PLAN OF IOWA 4 x x 52563 MERIDIAN HEALTH PLAN OF MICHIGAN 4 x x 64157 MERITAIN HEALTH 2 x x Formerly know as North American Administrators 85035 MESA MENTAL HEALTH 2 x 87726 MET LIFE x 2 x x 65113 METCARE HEALTH PLANS 2 x x 62168 METHODIST ASSOC HEALTH PLAN 2 x x 80314 METHODIST CARE 3 x x 13265 METRO PLUS HEALTH PLAN 2 x 10850 METROPOLITAN HEALTH PLAN (MHP) x 2 x x 87726 METROPOLITAN LIFE INS CO x 2 x x MWP01 METROWEST HEALTH PLAN-PREFERRED CARE 2 x 92579 MIAMI BEHAVIORAL HEALTH 2 x x 87726 MICHAEL REESE HMO x 2 x x 37281 MID-AMERICA ASSOCIATES, INC. 2 x x 90956 MIDLAND NATIONAL LIFE INSURANCE CO 2 x 47080 MIDLANDS CHOICE 2 x x 61146 MIDWEST GROUP BENEFITS 2 x x MHP77 MIDWEST HEALTH PLAN 2 x x 59224 MIDWEST NATIONAL LIFE INS CO – TN 2 x x MIDSC MIDWEST PREFERRED 2 x MIDSC MIDWEST SECURITIES 2 x 79480 MIDWEST SECURITY 2 x x MIDSC MIDWEST SECURITY ADMINISTRATORS (MSA) 2 x MIDSC MIDWEST SECURITY INSURANCE CO. (MSIC) 2 x MPMG1 MILLS PENINSULA MEDICAL GROUP 3 x 60054 MINNEAPOLIS PRUDENTIAL 2 x x 68068 MISSISSIPPI CBH (CENPATICO) x 3 x x The payer will be available with this payer ID effective 12/1/12. 64088 MISSISSIPPI SELECT HEALTH CARE 2 x x 37275 MISSOULA COUNTY MEDICAL BENEFITS PLAN 2 x x 13350 MODA HEALTH x 3 x formerly ODS Health Plan 13350 MODA HEALTH x 2 x formerly ODS Health Plan 38333 MOLINA HEALTHCARE OF CALIFORNIA 2 x x 51062 MOLINA HEALTHCARE OF FLORIDA 2 x x 38334 MOLINA HEALTHCARE OF MICHIGAN 2 x x 09824 MOLINA HEALTHCARE OF NEW MEXICO 2 x x 20149 MOLINA HEALTHCARE OF OHIO 2 x x 20554 MOLINA HEALTHCARE OF TEXAS 2 x x 38336 MOLINA HEALTHCARE OF WASHINGTON 2 x x ABRI1 MOLINA HEALTHCARE OF WISCONSIN 2 x x 50749 MONDIAL ASSISTANCE 2 x x 13174 MONTEFIORE CONTRACT MANAGEMENT ORG. 2 x x MMLI7 MONUMENTAL LIFE INS CO - BALTIMORE 4 x x Cancer MMLI6 MONUMENTAL LIFE INS CO - BALTIMORE 4 x x Cancer MMLI8 MONUMENTAL LIFE INS CO - CEDAR RAPIDS 4 x x Med Supp/Retiree Med MMLI9 MONUMENTAL LIFE INS CO - PLANO 4 x x Major Medical/Cancer MMLI5 MONUMENTAL LIFE INS CO - SCRANTON 4 x x Med Supp MMLI4 MONUMENTAL LIFE INS CO - VALLEY FORGE 4 x x Med Supp MMLI3 MONUMENTAL LIFE INS CO (HURST, TX) 4 x x Long Term Care MMLIC MONUMENTAL LIFE INS CO (LITTLE ROCK, AR) 4 x x Accident only, Cancer only, First occurrence invasive cancer, Heart disease attack or stroke only, Hospital confinement indemnity, Hospital intensive care MPI01 MOTION PICTURE INDUSTRY PENSION AND HEALTH PLAN 3 x x 36111 MOTOROLA, INC. 2 x 86040 MOUNTAIN STATES ADMINISTRATIVE SERVICES 2 x x 80900 MPA - CUSTOM PROVIDER NETWORK 2 x x 37233 MPE EMPLOYEE BENEFIT SERVICES, INC. 2 x x 95444 MPLAN, INC/HEALTHCARE GROUP, LLC 2 x x 95655 MT. CARMEL HEALTH PLAN 2 x x 34080 MULTIPLAN WISCONSIN PREFERRED PROVIDER NETWORK (WPPN) 4 x x 81883 MUNICIPAL HEALTH BENEFIT FUND 2 x x 37256 MUTUAL ASSURANCE ADMINISTRATORS 2 x x 21 of 124 Visit our web site: www.availity.com
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