Availity
NOTE:
The numbers provided in this configuration guide are subject to change without notice. It is your responsibility to maintain the accuracy of these numbers in your system.
Electronic Document Interchange (EDI) is a way to exchange data using a standard format and communication protocol. ChiroTouch supports a subset of EDI standards for Health Care that is mandated by HIPAA. This standard is created and maintained by the ANSI X12 committee. The current version of ChiroTouch includes support for the 837 (claim) and 835 (remittance advice) EDI transactions. The process of exchanging the EDI documents is called “document trading” and the parties involved in that process are called “trading partners”.
Before you can start trading EDI documents with Availity, you must complete the following tasks:
- Enroll with Availity
- Configure ChiroTouch for EDI
These tasks are described in greater detail later on in this document.
NOTE:
If you are currently submitting HCFA claim images to Availity, then you must contact their support department and switch the claims format for your user account from HCFA to ANSI X12 837. Availity does not support the submission of mixed claim formats. To minimize the downtime of your billing process, please ensure that your system is fully configured for EDI and that it has a low volume of unbilled charges before you switch from HCFA to ANSI claims.
Enrollment
To enroll with Availity clearinghouse, please contact them at:
URL: http://www.availity.com/about-availity/contact-us
Phone: 1-800-AVAILITY (282-4548)
At the end of the enrollment, you should receive your Customer ID, user name, and password for the web and/or FTP file uploading.
Important Note:ChiroTouch has been approved with Availity, and our vendor ID is 5010A1.
Availity EDI documentation and manuals: http://www.availity.com/documents/edi%20guide/edi_guide_toc.pdf
Availity Configuration
EDI makes use of several data identifiers that define key entities included on the exchanged documents. These include site, doctors, patients, payers, and trading partners. Using identifiers instead of names greatly reduces data entry mistakes and removes naming discrepancies between different organizations. The following section describes all data elements that need to be configured for successful EDI. Please refer to the ChiroTouch Manual for more information on how to use the EDI configuration screens.
Trading Partner Configuration
Availity is considered an electronic document trading partner for your organization. A trading partner in ChiroTouch is defined by a few data elements that are specified on the Trading Partners screen.
The table below shows all data elements that need to be specified for Availity. It does not show any elements that can be left with their default values.
IMPORTANT:
or some payers like BCBS of FL and Humana, Availity requires another Electronic Transmitter Identification Number (ETIN), also known as Submitter ID (loop 1000A field NM109), assigned by those payers. This requirement forces those payers to be created as independent Trading Partners in CT. Use BCBSF and Humana as Partner Names. When creating Trading Partner records for those payers, use the same configuration values as shown below except the ETIN. Please contact Availity for the site-specific Submitter ID (ETIN) for those payers. Set the folders for outbound and inbound transactions to be Availity\IN and Availity\OUT for all Availity-related Trading Partners. This will minimize the need for switching between multiple folders when uploading files to or downloading files from Availity.
|
Partner Name and Identifier: |
|
|
Organization Name |
Availity |
|
Identifier Qualifier |
Duns (Dun & Bradstreet) [01] |
|
Identifier Value |
030240928 |
|
ETIN |
030240928 |
|
Application Code |
030240928 |
|
Site Name and Identifiers |
|
|
Organization Name |
Site name is used automatically and it cannot be changed here |
|
Identifier Qualifier |
Mutually Defined [ZZ] |
|
Identifier Value |
AV09311993 |
|
ETIN |
The Customer ID assigned by Availity. For some payers such as BCBSF and Humana this ID is assigned by that payer. See the note above. |
|
Application Code |
5010A1 |
|
Transaction Options |
|
| Usage Indicator | Production |
|
835 File Name Mask |
*.era |
|
Control Characters |
|
| Segment Terminator | “~” Tilde |
| Element Separator | “*” Asterisk |
| Component Separator | “:” Colon |
| Repetition Separator | “^” Caret |
|
Registered Payers |
|
|
Primary Identifier |
User Payer ID from Health Plan Partners List available at http://www.availity.com/documents/edi%20guide/availity_edi_clearinghouse_health_plans_list.pdf. |
|
Secondary ID Qualifier |
Leave it blank |
|
Secondary Identifier |
Leave it blank |
|
Claim Filing Indicator |
Select the value that matches the payer type. It is important to use “Medicare B” for Medicare and “Blue Cross/Blue Shield” for BCBS. Other payers may use “Commercial Insurance” or whatever matches their type. |
|
Designated Partner |
Availity |
Site Configuration
Your site in many cases will be used as the EDI Billing Provider and Pay-To Provider for claims and remits. The table below shows all the data elements that need to be specified on the Site screen. It does not show any elements that can be left with their default values.
|
Billing Name and Address |
|
|
Name |
Your site billing name (same as in ChiroTouchMaintenance) |
|
Address Line 1 |
Your site billing address line 1 (same as in ChiroTouchMaintenance) Note: PO box is no longer accepted as a valid billing address |
|
Address Line 2 |
Your site billing address line 2 (same as in ChiroTouchMaintenance) |
|
City, State, and Zip |
Your site billing address city, state, and zip code |
|
NPI (type 2) |
A type 2 (organization) NPI assigned to your practice / site |
|
Employer Number / Tax ID |
A Tax ID assigned to your practice / site |
|
Taxonomy Code |
Leave it blank |
|
EDI Administrative Contact |
|
|
Name |
The name of the contact person in your office for EDI transmissions |
|
|
The e-mail of the contact person in your office for EDI transmissions |
|
Phone |
The phone of the contact person in your office for EDI transmissions Omit punctuation (ex: 2061231234) |
|
Fax |
The fax of the contact person in your office for EDI transmissions Omit punctuation (ex: 2061231234) |
Provider Configuration
Each provider that appears on the claim must be configured for EDI using the Providers screen. Other practitioners do not need to be configured. The table below shows common data elements that need to be specified for each provider. It does not show any elements that can be left with their default values.
|
EDI Rendering Provider |
|
|
Last Name |
Provider last name |
|
First Name |
Provider first name |
|
Middle Name |
Provider middle name (optional) |
|
Suffix |
Provider suffix |
|
NPI (type 1) |
A type 1 (personal) NPI assigned to the provider |
|
SSN |
Social Security Number of the provider |
|
Taxonomy Code |
A specialty code. The default taxonomy code for Chiropractor specialty is 111N00000X. Other codes are available at http://www.wpc-edi.com/taxonomy. |
Upload and Download File Location Configuration
Availity exchanges files using several options such as Web or secured file transfer protocol (SFTP). The SFTP protocol requires third-party FTP software to be installed on the user’s computer. Installation and configuration of third-party FTP software or usage of Availity web site is outside of the scope of this guide. Please refer to Availity EDI guide (http://www.availity.com/documents/edi_guide.pdf) for more information.
When uploading claim files, pick them from the path specified below (replace “servername” with the actual server name):
\\yourservername\CTData\EDI\Availity\OUT
When downloading ERA and report files, place them in path specified below (replace “servername” with the actual server name):
\\yourservername\CTData\EDI\Availity\IN
Please ask your IT professional if you don’t know your ChiroTouch server name.
Testing
There is no need to create and validate any test claim files with Availity as a site, because ChiroTouch has already been tested and approved with them as a vendor.
5010 Readiness
You may switch the version of claims from 4010 to 5010 under the “Trading Partner” screen once you have confirmed that Availity is ready to accept them for all payers.
ChiroTouch has already been tested and approved to use 5010 claims.