Electronic Data Interchange (EDI)

Amerigroup Community Care of New Mexico, Inc. uses Availity as its exclusive partner for managing all electronic data interchange (EDI) transactions. EDI, including electronic remittance advices (ERAs) and electronic funds transfers (EFTs), allows for a faster, more efficient and cost-effective way for providers and employers to do business.

EDI lets you:

• Process claims faster by submitting coordination of benefits electronically and fixing errors early with in-system notification and correction.
• Reduce overhead and administrative costs by eliminating paper claim submissions.
• Speed up enrollment and payment for employer groups benefits.
• Upload files through file transfer protocol (FTP) or directly in Availity as a batch or single claim submission.

For Amerigroup in Availity, you can complete the following HIPAA transactions:

• Healthcare Claim: Professional (837P)
• Healthcare Claim: Institutional (837I)
• Healthcare Claim: Dental (837D)
• Healthcare Eligibility Benefit Inquiry and Response (270/271)
• Healthcare Services Review and Response (278)
• Healthcare Services Inquiry and Response (278)
• Healthcare Claim Payment/Advice (835)
• Healthcare Claim Status Request and Response (276/277)
• Medical Attachments (275)

Ways you can use EDI with Availity

Availity’s EDI clearinghouse options:

• EDI clearinghouse for direct submitters
  • This is for organizations with fewer than 10,000 monthly transactions.
  • Submit batch files through the portal or Secure File Transfer Protocol (SFTP) using third-party software such as billing software.
• EDI clearinghouse for high-volume trading partners

Or use your existing clearinghouse vendor:

• Work with your vendor to ensure connection with the Availity EDI Gateway.

Payer ID

Payer IDs route EDI transactions to the appropriate payer.

Amerigroup Payer ID: 26375

Note: If you use a clearinghouse, billing service or vendor, please work with them directly to determine payer ID. These may be different when submitting the Amerigroup EDIs in Availity.

Electronic remittance advice (835)

The 835 eliminates the need for paper remittance reconciliation.

Use Availity to register and manage ERA account changes with these easy steps:

• Log in to Availity .
• Select My Providers > Enrollment Center > ERA Enrollment.

Note: If you use a clearinghouse or vendor, please work with them on ERA registration and receiving your ERAs.

Electronic funds transfer (EFT)

Electronic claims payment through electronic funds transfer (EFT) is a secure and fast way to receive payment, reducing administrative processes. EFT deposits are assigned a trace number that is matched to the 835 Electronic Remittance Advice (ERA) for simple payment reconciliation.

As of November 1, 2021, use enrollsafe.payeehub.org to register and manage EFT account changes.

Electronic data interchange trading partner

The trading partner such as clearinghouse, billing company and vendor connects with Availity’s EDI Gateway to send and receive EDI transmissions easily.

Contact Availity

Please contact Availity Client Services with any questions at
1-800-AVAILITY (282-4548) Monday to Friday, 8 a.m. to 7:30 p.m. Eastern time.