24-479 Submit Claims Online With Availity, and Access ERAs and EFTs Through Electronic Data Interchange
Date: 05/30/24
Go paperless and use EDI technology to help reduce time spent on claims-related issues
Electronic Data Interchange (EDI) has a variety of tools to help you track electronic claims status, improve timely filing and access daily accept/reject reports. This converts to easier receivables and account reconciliation.
When you use our approved vendors and clearinghouses, Health Insurance Portability and Accountability Act (HIPAA) compliance is done for you and gives you automatic access to highly secure and time-tested solutions. This cuts down on the time spent ensuring HIPAA compliance and problem-solving claim issues.
How EDI works
Successful EDI claim submission requires the use of electronic reporting made available through your vendor and/or clearinghouse. Health Net, on behalf of Community Health Plan of Imperial Valley, returns claims acknowledgements to the clearinghouse with notifications of acceptance or rejection of individual claims. You can review these reports to check the status of their submission.
Register with Availity to submit claims
The Plan contracts with Availity to provide claims clearinghouse services for Health Net claim submissions. Availity will work with your clearinghouse or vendor to submit claims to Health Net in a timely manner.
Once you register with Availity, you can:
- Submit claims electronically.
- Submit claims directly through the Availity portal.
- Check claims status.
- Submit corrected claims.
- No changes in claims processing and payment.
Sign up for Availity
- Go to availity website.
- Select Get Started next to ‘New to Availity?’ at the top right of the landing page.
- Select Create Account button.
Above the ‘Create Account’ button, select training site and follow the prompts, which will direct you to a page that lists questions and answers related to registering for an Availity account.
How can I get help with registering for an account
For help with setting up an Availity account, contact client services at 800-282-4548.
Available trainings offered by Availity
After you have registered with Availity, you can access training demos, live and recorded webinars and more. Below are examples of available training demos:
- Professional Claim
- Facility Claim
- EDI Reporting Preferences
- Send and Receive EDI Files
- Getting Started With Electronic Data Interchange (EDI) on Availity Essentials – Recorded Webinar
- Claim Status
Register for electronic remittance advice
Physicians and other providers can register to receive an electronic remittance advice (ERA). This feature reduces administrative work and claims-related problems.
- ERAs give providers details regarding multiple claims.
- They improve providers' business office workflow by allowing the adjudicated claim information to automatically post to accounts receivable systems.
- ERAs are sent to any provider who registers with Availity and are available in all Plan service areas.
- Register online for ERA.
Register for electronic funds transfer
Electronic funds transfer (EFT) automates the distribution of funds into providers' accounts, allowing money to be moved from one account to another.
- EFT is safe, secure, efficient, and less expensive than paper check payments and collections.
- Register online for EFT.
Note: ERA and EFT require separate registration. You can register for just ERA, just EFT or both.
More information
For EDI-related questions, please email or call 800-225-2573, ext. 6075525.
Visit EDI website for more details about EDI and how it can help you and your practice.
Additional information
If you have questions regarding the information contained in this update, contact Community Health Plan of Imperial Valley at 833-236-4141. Behavioral Health providers can call 844-966-0298.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers, and Behavioral Health Providers.
This information applies to Medi-Cal in Imperial county.