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Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name Payer ID Additional Information Availity Required Forms (links) Payer Specific Forms (links) MEDICARE PART B NEW MEXICO 04212 MEDICARE PART B OKLAHOMA 04312 MEDICARE PART B OREGON 02302 MEDICARE PART B TEXAS 04412 38 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. ERA receiver number = EJ40230. For Novitas ERA Enrollment Form: 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 H: ELECTRONIC REMITTANCE ADVICE (ERA): Select Assign ERA to an existing submitter/receiver ID: enter submitter ID EJ40230 Availity Multi-payer Form Novitas ERA Enrollment Form Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer. ERA receiver number = EJ40960. For Novitas ERA Enrollment Form: 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 H: ELECTRONIC REMITTANCE ADVICE (ERA): Select Assign ERA to an existing submitter/receiver ID: enter submitter ID EJ40960 Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing Availity Multi-payer Form Novitas ERA Enrollment Form ERA enrollment with the payer Availity Multi-payer Form EDISS Total OnBoarding Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer. ERA receiver number = E13075. For Novitas ERA Enrollment Form: 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 H: ELECTRONIC REMITTANCE ADVICE (ERA): Select Assign ERA to an existing submitter/receiver ID: enter submitter ID E13075 Availity Multi-payer Form Novitas ERA Enrollment Form
Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name Payer ID Additional Information Availity Required Forms (links) Payer Specific Forms (links) MEDICARE PART B WASHINGTON 02402 Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer Availity Multi-payer Form EDISS Total OnBoarding MEDICARE RAILROAD 00882 Click the link named “EDI_Enroll_RR_Pack.pdf” to open the form. The following Availity information is necessary on page 9 of the Medicare 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, Claim Submission Mode of Communication - Connect Direct: (NDM), Report/Electronic Remittance Mode of Communication - Connect Direct: (NDM), Request Response Format - File, Data Compression - PKZIP. Check “Submit Claims”. Check the box “Receive Electronic Remittances”. NOTE: You must complete the Availity Multi-Payer Form prior to submitting the EDI Enrollment form to Medicare. Complete page 13. On page 16, check “Electronic Claims Submissions". Check “Electronic Remittance”. Complete page 16 with your information. Contact the EDI help desk 866.749.4301, or email medicare.edi@palmettogba.com for questions. Availity Multi-payer Form MEGA LIFE & HEALTH INS. (STUDENT NPI number is required on the Multi-Payer INSURANCE) 59221 Registration Form for processing. Availity Multi-payer Form MEMORIAL CLINICAL ASSOCIATES MCA11 Please use payer id HPN11 to register. Availity Multi-payer Form 39 of 124 Visit our web site: www.availity.com Availity® Health Information Network Electronic Data Interchange (EDI) & Web Solutions Companion Guides Railroad Medicare EDI Enrollment Packet (click link for EDI_Enroll_RR_Pack.pdf)
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