Availity, LLC

Availity, LLC, is a full service clearinghouse capable of handling all of your electronic claim submission needs. Claims formerly submitted on paper can now be submitted electronically using the HIPAA-compliant Expanded National Standard Format (NSF) version T0301, Expanded UB92 version T60 or ANSI 837 4010A1 formats. Use of electronic claims submission will reduce the administrative cost of submitting claims. It also reduces the possibility of data errors, providing quicker turnaround on claims processing.

• Features
• Requirements
• Guidelines for potential submitters
• Payors who accept electronic claims through the clearinghouse
• Software vendors and clearinghouses that have successfully tested with the clearinghouse

• Capable of handling electronic claims from all types of physicians, dentists, other professional providers, healthcare facilities, independent laboratories, vision care, ambulance services, and suppliers of durable medical equipment
• All lines of Regence BCBSO and Regence HMO Oregon business, including Federal Employee Plan (FEP) can be submitted through Availity, LLC as well as claims for other payors. Claims for payors with whom there is no electronic connection will be printed on paper by Availity, LLC and submitted as paper claims to the payor. For this service, Availity, LLC will charge first rate postage per claim. View a list of major payors who accept electronic claims through Availity, LLC.
• No submission charges for claims sent directly to Availity, LLC to carriers who accept electronic claims as long as you are submitting all your Blue Cross and Blue Shield claims to us
• Compliant with the Health Insurance Portability and Accountability Act (HIPAA)
• Easy batch submission through a toll-free telephone number or PGP encrypted internet connection
• Detailed online submission and error reports and real-time editing of claims online

Example reports are available on the Availity, LLC Web site under Section 5A - Reports.

Requirements

In order to submit claims electronically through Availity, LLC, provider offices or billing services must use the HIPAA-translatable Expanded National Standard Format (NSF) version T0301, Expanded UB92 version T60 or ANSI 837 4010A1 formats. Submitters must also maintain a backup file sufficient to recreate the claims file should the original be damaged. While there are no requirements for producing hard copy claims, the provider must maintain source documentation. Regence BCBSO must be given reasonable access to this documentation in order to audit and confirm information submitted on any electronic claim. Please contact your software vendor or billing service, if applicable, to begin the process of submitting claims. If you do not currently work through a clearinghouse or billing service, contact Availity, LLC EDI Helpline via phone at (800) 282-4548 or by e-mail at THIN@THINEDI.com.

Guidelines for Potential Submitters

1. Obtain software capable of transmitting claims in the HIPAA translatable NSF VT0301, UB-92, VT60 or the ANSI 837 4010A1 formats. View a list of software vendors and clearinghouses that have successfully tested with us.
2. Once you have the capability, you need to test with your vendor or clearinghouse. Your vendor, clearinghouse or programmer will also need to test using a free, submitter-controlled testing tool called EDIFECS that verifies your HIPAA transactions over the Web in real time, if they are not already in production with Availity, LLC using a HIPAA compliant format. This tool is provided by Regence BCBSO to aid in compliance testing for HIPAA transactions. You can obtain a password to access EDIFECS by contacting the Regence eBusiness Support Center at (800) 737-1477.
3. Download an enrollment packet from Availity, LLC or contact the Availity, LLC EDI Helpline via phone at (800) 282-4548 or by e-mail at THIN@THINEDI.com.
4. Transmit test claim files. After successful testing, contact the Availity, LLC EDI Helpline to request production (live) status.