Availity® Health Information Network

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Availity® Health Information Network Electronic Data Interchange (EDI) & Web Solutions Companion Guides Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name Payer ID Additional Information Availity Required Forms (links) Payer Specific Forms (links) FRESENIUS FMCHP Please use payer id FMCHP to register. NPI number is required on the Multi-Payer Availity Multi-payer Form GEHA MENTAL HEALTH CLAIMS 87726 Registration Form for processing. Availity Multi-payer Form GENERAL AMERICAN LIFE INS CO 63665 Cigna_ERA_835_Enrollment GENERATIONS HEALTHCARE GHEDI Please use payer id GHEDI to register. Availity Multi-payer Form GOLDEN TRIANGLE PHYSICIAN ALLIANCE GTPA1 Please use payer id GTPA1 to register. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Availity Multi-payer Form GRANITE STATE HEALTH PLAN 68068 Centene for further instructions. Includes ERAs for plans formerly known as First Availity Multi-payer Form Centene_ERA_835_enrollment GWH-CIGNA (FORMERLY GREAT-WEST Great West Life and Annuity Ins Co and Great-West HEALTHCARE) 80705 Life and Annuity Ins Co. Cigna_ERA_835_Enrollment HEALTH SERVICES MANAGEMENT 41150 Availity Multi-payer Form HSM 835 ERA ERA/EFT Setup-Maintenance Request HEALTH VALUE MANAGEMENT 61101 System HealthPartners Electronic Claims Enrollment HEALTHPARTNERS 07003 Form HERITAGE PHYSICIAN NETWORK (HOUSTON) HPN11 Please use payer id HPN11 to register. Availity Multi-payer Form Electronic Remittance Advice (ERA) Enrollment Form (HCSC ERA Enrollment HMO BLUE 84980 Form) Electronic Remittance Advice (ERA) Enrollment Form (HCSC ERA Enrollment HMO BLUE TEXAS 84980 Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Form) HOME STATE HEALTH PLAN 68068 Centene for further instructions. Availity Multi-payer Form Centene_ERA_835_enrollment ERA/EFT Setup-Maintenance Request HUMANA, INC. (CLAIMS) 61101 Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact System ILLINICARE HEALTH PLAN 68069 Centene for further instructions. Availity Multi-payer Form Centene_ERA_835_enrollment IMCARE 41600 Please complete Availity’s Multi-payer enrollment Availity Multi-payer Form form prior to visiting the payer’s site and completing Kaiser Foundation of Ohio EDI Claim Remits KAISER FOUNDATION OF OHIO KP014 ERA enrollment with the payer Availity Multi-payer Form Setup Form KATY MEDICAL GROUP KMG11 Please use payer id HPN11 to register. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Availity Multi-payer Form KENTUCKY SPIRIT HEALTH PLAN 68069 Centene for further instructions. Availity Multi-payer Form Centene_ERA_835_enrollment For 835 enrollments please click this link and fill out the payer enrollment form. Once you have received a confirmation email from the payer, you may submit the Availity Multi Payer NPI number is required on the Multi-payer Form for Form to us to complete the enrollment LANDMARK HEALTHCARE LNDMK processing. Availity Multi-payer Form process. ERA/EFT Setup-Maintenance Request LINCOLN NATIONAL (HUMANA) 61101 Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact System LOUISIANA HEALTHCARE CONNECTIONS 68069 Centene for further instructions. Availity Multi-payer Form Centene_ERA_835_enrollment 32 of 124 Visit our web site: www.availity.com
Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name Payer ID Additional Information Availity Required Forms (links) Payer Specific Forms (links) MAGELLAN HEALTH SERVICES 01260 Availity Multi-payer Form MAGNOLIA HEALTH PLAN 68069 Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. NPI number is required on the Multi-payer Form for Availity Multi-payer Form Centene_ERA_835_enrollment MAILHANDLERS MENTAL HEALTH CLAIMS 87726 processing. Availity Multi-payer Form ERA/EFT Setup-Maintenance Request MANAGED CARE INDEMNITY 61101 Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact System MANAGED HEALTH SERVICES - IN 68069 Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Availity Multi-payer Form Centene_ERA_835_enrollment MANAGED HEALTH SERVICES - WI 68069 Centene for further instructions. Availity Multi-payer Form Centene_ERA_835_enrollment ERA/EFT Setup-Maintenance Request MANAGED PRESCRIPTION SERVICES 61101 System MAYO MANAGEMENT SERVICES 41154 Availity Multi-payer Form ERA/EFT Setup-Maintenance Request MEDBENEFIXX INC 61101 Please note the providers will be automatically registered for UnitedHealthCare's 835s in order to ensure Medica ERA delivery. NPI number is required on the Multi-Payer Registration Form for System MEDICA CHOICE (ALLINA) 94265 processing. Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer. To register for Florida Medicaid, first complete the Availity FL Medicaid Registration Instructions. Once your Availity Multi-payer Form MEDICAID FLORIDA 77027 Florida Please complete Availity’s Multi-payer enrollment Availity Multi-payer Form Florida Medicaid Trading Partner Setup form prior to visiting the payer’s site and completing Please contact Idaho Medicaid at MEDICAID IDAHO AIDID ERA enrollment with the payer Availity Multi-payer Form 866.686.4272 option 2 MEDICAID KENTUCKY AIDKY MEDICAID MINNESOTA DPWMN MEDICAID MISSOURI 70029 33 of 124 Visit our web site: www.availity.com Availity® Health Information Network Electronic Data Interchange (EDI) & Web Solutions Companion Guides Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer. Availity's Trading 835/U277 Request form Electronic Partner/Submitter ID is 9900004190. Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer. Once on the payer's site, complete the ‘Submitter Information’ with the following: Submitter ID (UMPI) - A268453200; Submitter Name – Availity LLC; Address – 740 E Campbell Rd, Suite 1000, Richardson, TX 75081; Phone – 800.282.4548 Availity Multi-payer Form Remittance Advice (ERA) Please complete the Availity Multi-payer Form prior to completing the 5010 Outbound Trading Partner Availity Multi-payer Form EDI Submitter Enrollment Form Agreement for FTP Users to avoid 835s delivering 5010 Outbound Trading Partner Agreement incorrectly. Availity Multi-payer Form for FTP Users
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