Choosing a Clearinghouse: Office Ally or Availity?

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, 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. 

To break it down, Availity charges by the claim, Office Ally by the NPI number.  We recommend Availity when you are billing several different NPIs (i.e., the RBTs have their own NPI numbers) like with Tricare West or Medicaids.  Either way, the ERAs come back through Office Ally so you will need an account with them and all ERAs will be completed with them.

Checking Payers in Office Ally

To search for your payer, go to this link here: Office Ally Payer List 
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: Office Ally Pricing 
Office Ally: In general, OA charges 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: Payer ERA Enrollment Forms 
  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.

Checking Payers in Availity

To search for your payer in Availity, go to this link here: Availity Payer List 

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. 

  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. 
Pricing: Contact Availity directly for pricing info for EDI plans.
  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. 

Integrate with a Clearinghouse


Complete the Office Ally integration if you are using either Office Ally or Availity for claims.  Your ERAs will come back through Office Ally either way!

Office Ally Integration:  Please send the SFTP Username and Password to your CSM once you’ve received it from Office Ally

Office Ally ERA enrollment

  • ERAs can be found at Office Ally 🡪 Resources 🡪 Payer ERA Enrollment Forms and should be listed alphabetically.  They should be completed for all payers that you work with


Office Ally EDI Enrollment

  • Double check to see if you need to complete any EDIs for payers you are billing in Office Ally (Office Ally 🡪 Resources 🡪 Payer EDI Enrollment Forms and should be listed by state)

Availity Integration Instructions:  Please send your CSM the SFTP Username and Password once you’ve created it.


Availity EDI Enrollments

  • Make sure to complete all EDI enrollments required (i.e., enroll in an EDI plan if required for your payer)

Availity ERA Delivery Change Form

  • Since your ERAs enrollments are done in Office Ally, please complete the ERA Delivery Change Form attached to this article if you are using Availity for billing.

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