Availity EDI Clearinghouse Integration

Availity EDI Clearinghouse Integration

FYI: ERAs from Availity are not being posted back to Aloha automatically to the Payment Center at this time. If you'd like your ERAs to be auto posted, please see the following steps at the bottom of this article. They will need to be routed from Availity to Office Ally in order for our system to be able to recognize and receive the ERA files from claims billed out through Availity. This is being worked on and will be updated once we can directly receive ERAs from Availity. There is no extra charge associated with receiving the ERAs from Office Ally. 

In order to bill through the Availity EDI Clearinghouse, you will need to do a few different steps to get set up. Below is a general outline of the different parts you will need to get set up. 

  1. Register for an Availity EDI Clearinghouse Account and choose the appropriate upgraded plan for the payers you will be billing.  

  1. Once you have access, create your SFTP username and password (this allows files to be transmitted between Aloha and Availity)  

  1. Check the Availity Payer list and complete any necessary EDI and ERA forms for your payers.  

  1. Adjust the EDI Reporting Preferences Configuration in your Availity settings (exact settings to select are listed below)

    1. These settings need to be adjusted so that we can receive file formats appropriately for the different things that will be coming back from Availity, including rejections, acceptances, denials, and remittances.  

  1. In Aloha, all addresses that will be included on the CMS1500 form need to have 9 digit zip codes. You can use this link to easily search for the zip code: USPS Zip Code Locator 

    1. Client profile  

    2. Client contact (if the insured name is a parent)  

    3. Payer profile 

    4. Organization and all offices 

  1. On all your payer profiles that you plan to bill using Availity, make sure you select “Availity” in the clearinghouse field.  


Create your Availity Account 

  1. Go to www.availity.com and click Register  

  1. Review the Availity Payer List at Availity Payer List to obtain payer IDs and to check if your payers are participating payers 

  2. Upgrade your plan if necessary:  Next to the 837P transaction type, you may see "Get EDI Plan" or "Available" here. 

    1. Available means that no further action is needed in order to bill this payer through the clearinghouse.  The base plan (free) will suffice in this scenario.
    2. Get EDI Plan means that you need to upgrade your Availity account to be able to bill this payer electronically through the clearinghouse. Clicking this link will prompt you to upgrade your account if you have not done so already.  From here you can chose a "comprehensive plan" based on the number of transactions you will likely need.


 

Create your SFTP Account 

  1. Log in to your Availity account  
  2. At the top, click “Claims & Payments” 
  1. Under the “EDI Clearinghouse” section, select “FTP and EDI Connection Services” 
  1. Click “Manage your FTP Mailbox” 
  2. Select your organization  
  1. Create your FTP username and password and save.  
  1. This information will need to be added to your Aloha site in order to connect the clearinghouse and allow you to start billing. Copy and paste this username/password and email it to your Customer Success Manager at Aloha so we can add this to your site for you.  
  1. Done!  

 

Connect Availity Credentials to your Aloha site: 

You can forward your credentials (username and password) to your CSM and they will help you complete this step.  

  1. In Aloha, go to Settings on the left hand side.  

  1. Select System Settings 

  1. In the top right box under “Clearing House Integration” click the blue + button and add Availity.  

  2.  

  3. The following values need to be added:  

    1. Sender ID: AV09311993 

    2. Sender ID Type: Mutually Defined 

    3. Receiver ID: 030240928 

    4. Receiver ID Type: Duns (Duns & Bradstreet)  

    5. SFTP Host: ftp.availity.com  

    6. Port: 9922 

    7. SFTP Username and password: the account information you created in the previous section  

    8. SFTP Download Folder: ReceiveFiles 

    9. SFTP Upload Folder: SendFiles  


3. Once finished, click "Test Connection" and it should be successful. Save, and you're done 


Edit your EDI Reporting Preferences on Availity: 

Once you begin sending claims out, we will need the files to come back into Aloha and to appear in the file format that is acceptable for our system to process. To ensure your settings are correct, please make sure they match the screenshots below. To get to this section in Availity:  

  1. On Availity, click on “Claims & Payments” at the top. 

  1. Select “EDI Reporting Preferences”  

  1. Select your organization name 

There are many settings that can be adjusted here, but please copy the following settings from the screenshots below. Don’t forget to click save when you’re done!  

  

 


Route ERAs from Availity to Office Ally in order to Auto-post payments in Aloha: 

At this time, ERAs will need to be filled out through Office Ally, even if you are using Availity as your clearing house.  In addition to setting up your Availity integration, please use the following steps to complete your ERAs in Office Ally in order to auto-post your payments.  This will save a lot of time when large payment start coming in!
  1. Set up an account with Office Ally (steps 1 and 2):  Office Ally Integration
  1. Email support@alohaaba.com or your CSM the SFTP username and password that you create in Office Ally
  2. Fill out ERAs for your payers in Office Ally
  3. ERAs can be found under the Resources tab on the top of the Office Ally page 
  4. ERAs need to be filled out for EVERY payer and are listed alphabetically by payer.  Payer ERA Enrollment Forms 
  5. If you cannot find the ERA instructions for a payer please feel free to reach out to your Customer Success Manager. 
  6. Fill out ERA Delivery Change Form (attached to this article) to ensure that using Availity as a clearinghouse will not disrupt the return of the ERAs through Office Ally.  
  7. Once you begin getting paid, ERAs will appear automatically in Aloha under the "Payment Center". You can double click each ERA that you see here to auto post the payment.  

Note:  You will not be charged by Office Ally for this since your claims will be going through Availity.



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