Receiving payment

Professional reimbursement

Learn about our professional reimbursement methodology.

Overpayment recovery

Payments are occasionally recouped due to a duplicate or adjusted claim. View instructions for responding to a recoupment request.

Pricing disputes and appeals

Pricing disputes are not appeals and follow a different process. Identify the correct process to follow when submitting a pricing dispute or appeal.

Grace periods

Learn how submitted claims may be impacted by the three-month grace period for premium payment for patients on an exchange product

Provider payment information

Our remittance advices are generated weekly and include details about how each claim was processed.

Other payment information

View procedures not covered and the responsibilities of participating providers.

Provider audits

Audits determine medical necessity, utilization, coverage and appropriateness of services, and accuracy of claims submitted.

BlueCard Program

Learn more about the BlueCard claims payment process and payment rates.

ANSI 835 Electronic Remittance Advice (835 ERA)

CCD Re-association data elements

Corresponding ERA (835 V5010) data elements

CCD Record number

Field number

Field name

Data element segment

Data element name

Availity's remittance viewer

5

9

Effective entry date - date the payer intends to provide funds to the payee via EFT

BPR16

EFT effective date

N/A

6

6

Amount

BPR02

Payment amount

N/A

7

3

Payment-related information - payment-related ASC X12 data segments

TRN02 and TRN03

EFT Trace Number and Payer Identifier

Check/EFT trace number