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.
Register for an Availity EDI Clearinghouse Account and choose the appropriate upgraded plan for the payers you will be billing.
Once you have access, create your SFTP username and password (this allows files to be transmitted between Aloha and Availity)
Check the Availity Payer list and complete any necessary EDI and ERA forms for your payers.
Adjust the EDI Reporting Preferences Configuration in your Availity settings (exact settings to select are listed below)
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.
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
Client profile
Client contact (if the insured name is a parent)
Payer profile
Organization and all offices
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
Review the Availity Payer List at Availity Payer List to obtain payer IDs and to check if your payers are participating payers
Upgrade your plan if necessary: Next to the 837P transaction type, you may see "Get EDI Plan" or "Available" here.
- 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.
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.
Log in to your Availity account
At the top, click “Claims & Payments”
Under the “EDI Clearinghouse” section, select “FTP and EDI Connection Services”
Click “Manage your FTP Mailbox”
Select your organization
Create your FTP username and password and save.
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.
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.
In Aloha, go to Settings on the left hand side.
In the top right box under “Clearing House Integration” click the blue + button and add Availity.
The following values need to be added:
Sender ID: AV09311993
Sender ID Type: Mutually Defined
Receiver ID: 030240928
Receiver ID Type: Duns (Duns & Bradstreet)
SFTP Host: ftp.availity.com
Port: 9922
SFTP Username and password: the account information you created in the previous section
SFTP Download Folder: ReceiveFiles
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:
On Availity, click on “Claims & Payments” at the top.
Select “EDI Reporting Preferences”
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!
Email support@alohaaba.com or your CSM the SFTP username and password that you create in Office Ally Fill out ERAs for your payers in Office Ally
ERAs can be found under the Resources tab on the top of the Office Ally page
If you cannot find the ERA instructions for a payer please feel free to reach out to your Customer Success Manager.
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.
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.
Related Articles
Choosing a Clearinghouse: Office Ally or Availity?
Now that you've decided to use a Clearinghouse for billing, it is important to understand how to find your payers properly in your clearinghouse and whether or not they are premium payers that require an upgraded plan. When searching for your payers, ...
Correcting Claims in Availity/Aloha
After you’ve processed claims through Aloha to get sent to Availity, you may encounter a situation where you need to fix or correct a claim. Before we get started, let’s define these words: Rejection: When a claim is rejected, the claim must be fixed ...
Secondary Billing in AlohaABA
Secondary Billing in Aloha ABA Step by step guide to setting up and billing secondary claims in Aloha FYI: As of 7/3/24, our Secondary Billing feature will exclusively support Office Ally as the selected clearinghouse at this time. Our team is ...
Preparing for Aloha's Insurance Billing Services
Welcome to the Aloha family! We're super excited for you to move forward with using Aloha's billing services. Before you meet your assigned RCM manager from the Aloha Billing team, please complete the following steps: Required Steps to ensure ...
Billing Overview
Getting Ready to Bill It is vital to have the correct information in the system to submit for billing. Make sure you have the correct Payer ID (double check in Office Ally Payer List) and have completed eligibility checks for your clients to ensure ...