Understanding Payers in Office Ally and Availity

Understanding Payers in Office Ally and 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, it is important to search them in the appropriate clearinghouse's payer list, because each insurance company can have a different payer ID depending on which clearinghouse you are using. Payer IDs help to identify where your claims should be submitted to. 

In Office Ally: 
To search for your payer, go to this link here: https://cms.officeally.com/Pages/ResourceCenter/PayerLists/PayerList.aspx 
You can also access this by clicking on Resources > Payer List. 

In the "Search Payers" box, you can type in a payer name or search by payer ID. 
The Payer list in Office Ally will show you the payer name, their ID, the type of transactions you can process with them, and a few other important details.  Below is a breakdown of the category definitions: 
  1. Payer name: The name of the payer as identified in Office Ally. This name does not need to be identical to what is entered in Aloha necessarily, but what matters most is that the payer ID is the right one for the payer you are looking to bill. 
  2. Payer ID: a unique 6 digit value that identifies this payer within Office Ally. Verifying your Payer ID will ensure that your claims are being sent to the correct place. 
  3. Transaction: Look for the one next to your payer name labeled "Professional Claims - 837P". or "Remits - 835". These are the file types that are processed for sending CMS1500 claims out from Aloha and receiving EOBs/ERAs back into Aloha. 
  4. Available: when the checkmark is checked for payer and available, this means this payer can be billed and processed through Office Ally. 
  5. Non par: when this checkmark is checked, this means the payer is a non-participating payer and would require you to pay an additional fee in order to bill them through Office Ally. For a breakdown of Office Ally's pricing, visit this link: https://cms.officeally.com/pricing 
Office Ally: In general, OA charges $35 per tax ID + Rendering Provider NPI combination whose claim volume is 50% or more to Non-Par payers in a month. For tax ID + rendering provider NPI combinations where < 50% of claims are from Non-par payers, there is no additional cost.
  1. Enrollment: This is only relevant for 835 transactions, meaning ERA enrollment for the selected payer. When this box displays an !, it means this payer requires enrollment to receive ERAs automatically. ERA enrollment forms for your payer can be found at this link: https://cms.officeally.com/Pages/ResourceCenter/PayerERAEnrollmentForms.aspx 
  2. Secondary: This checkmark indicates that the payer allows electronic secondary billing submission through Office Ally. If it is not checked, it means that you'd have to bill this payer for secondary manually through paper submission. 
  3. Notes: This can be useful to check if there is anything additional you should know about the payer. This typically tells you if a payer needs you to fill out an ERA form, their customer service number, and sometimes if the payer goes by another name when you're searching for their EDI/ERA form.

In Availity: 
To search for your payer in Availity, go to this link here: https://apps.availity.com/public-web/payerlist-ui/payerlist-ui/#/ 

You can search a payer by their name or by their Payer ID if you have it. Once you search and find your payer, you will see a few different categories next to the transaction type. The transaction type you are looking for within Availity is 837P (Professional Encounters) and Claim Payment/Advice - Remittance (835)


  1. Portal: You may see "Available" or "Get Essentials Plus" here.
    1. This means that this payer's portal is through Availity and is either free to use , or requires an upgraded plan to their Essentials Plus: https://www.availity.com/essentialsplus 

  1. Batch: Next to the 837P transaction type, you may see "Get EDI Plan" or "Available" here. 
    1. 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. 
    2. Available means that no further action is needed in order to bill this payer through the clearinghouse. 
Availity: Starting at $35/month, you can pay per transaction volume. Each transaction costs anywhere between $0.09 and $0.065 depending on the monthly plan that you upgrade your account to. Full pricing breakdown can be found at this link here: https://www.availity.com/ediclearinghouse/direct-submitters 
  1. Enrollment Required: If this box displays a checkmark, it means that this payer requires enrollment to receive 835 Claim Payment/Remittance Advice (ERAs) back electronically. The enrollment forms can be found within the Availity portal. 

    • Related Articles

    • Office Ally Integration

      Before you can bill through Office Ally, you'll need to complete a few steps. This process is fairly easy, the longest part of the process will be enrolling your payers to receive ERAs within Office Ally. Create an Office Ally account if you haven't ...

    • 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 ...

    • Correcting Claims in Office Ally/Aloha

      After you’ve processed claims through Aloha to get sent to Office Ally, 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 ...

    • How to determine if you need an EDI pre-enrollment for your payer in Office Ally

      How to determine if you need an EDI pre-enrollment for your payer in Office Ally Go to the link below: https://cms.officeally.com/payerlist Then, under search payers, enter the payer name or payer ID then find the payer that you are looking for and ...

    • Secondary Billing Instructions in Office Ally

      Aloha Secondary Billing: FYI: 1/24/24 - Secondary billing within Aloha is not available. The steps in this current article below are to show you how to bill to secondary within Office Ally's site. We recommend "fake billing" in Aloha so that claims ...