Payment information

Learn about our professional reimbursement methodology.

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

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

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

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

View procedures not covered and the responsibilities of participating providers.

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

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