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.

Appeals

Our appeals process includes adverse determinations, external audit and investigation, provider contract termination and medical or reimbursement policy reconsideration.

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

We provide claims processing information in an ANSI 835 Electronic Remittance Advice (835 ERA) format.

You can use the options below to obtain your claims payment information. Enrollment is quick and easy and there is no cost to you.

  • View claims payment information online in human-readable format using Availity's Remittance Viewer.
  • Receive your remittance advice electronically via an ANSI 835 ERA. Enrollment is quick and easy and there is no cost to you.

Enrollment

Receive your claims processing information for your Regence patients via an 835 ERA.

Enroll on the Availity Provider Portal: My Providers>Enrollments Center>Transaction Enrollment.

Electronic funds transfer (EFT)

Claim payments via EFT is a requirement for participation in our networks. In addition, we require all provider claims to be submitted electronically. If you’re not already receiving payments via EFT, please register now.

To register for EFT

Receive fast, secure delivery of your claim's payments, use Availity's Transaction Enrollment Tool.

The Transaction Enrollment Tool is available on the main menu of the Availity Portal: My Providers>Enrollments Center> Transaction Enrollment. You can view a dashboard with updates and the status of your EFTs.

Pharmacies:

  • Medical pharmacy claims and service: Sign-up for EFT using Availity's Transaction Enrollment Tool
  • Pharmacy claims and services: Sign-up for EFT by contacting Prime Therapeutics at 1 (844) 765-6827

You will receive a confirmation email from Availity when your EFT registration is submitted and an email from us when your EFT set-up is complete. Upon completion, the next claim payment cycle will be sent electronically to your designated account.

EFT deposits will be made two business days after the payment issue date to comply with National Automated Clearing House Association (NACHA) guidelines. Note: We will make only credit entries to your designated bank account. If it becomes necessary to initiate a correcting debit, we will notify you in advance.

Updating your EFT information

If you change bank accounts, submit a change request using Availity's Transaction Enrollment Tool.

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

Prompt payment regulations

We make every effort to pay or deny clean claims within thirty (30) days of receipt. A clean claim is a claim submitted on a properly completed paper or electronic claim form that does not require any additional documentation or information to determine our liability for payment. We determine what claims do not require substantiating documentation from the provider, information from a third party, or further review to determine our liability for payment.

Some types of claims are excluded from Prompt Pay laws, depending on individual state statutes and/or federal law. The following claims are commonly excluded:

  • BlueCard
  • Pharmacy
  • Medicaid entities
  • Capitated agreements
  • Claims paid to members
  • Regence Bridge Medigap
  • Medicare Advantage Plans
  • Federal Employee Program
  • Non-participating provider claims
  • Administrative services only (ASO) groups

Please refer to your state's Prompt Pay statutes:

  • Idaho: Idaho Code 41-5602 and 41-5603
  • Oregon: ORS 743.911 and ORS 743.913
  • Utah: Utah Code 31A-26-301, 31A-26-301.5 and 31A-26-301.6
  • Washington: WAC 284-43-321

Additional information regarding timely payment is available in your agreement.

View detailed information on claim submission and direct and timely billing.