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Availity Clearinghouse Functionality with Ankota Files

Overview

Availity provides clearinghouse services. Please note that in most states, Availity requires a paid account for most payers. 


This article includes:

Enrolling in Availity

Automated Availity Claims Management

Billing/Preparing the Availity 837

Manual Upload Availity Claims Management

Billing/Preparing the Availity 837

Uploading Files in Availity

Reviewing Files in Availity

Remittance Advice Files

Troubleshooting


Enrolling in Availity

In order to successfully use Availity's clearinghouse services, you will need to complete the following steps:



In order to have automated SFTP transfer to Availity (as opposed to manually uploading your 837s), you will also need to get a user name and password from Availity and share them with Ankota. 

To create them,


Automated Availity Claims Management

Billing/Preparing the Availity 837

Customers can sign up for automated file transfer to Availity, speeding up the data delivery process with Availity. Once this is set up, your data transferral is automated upon billing. You will still need to manage your rejections. 

To ensure successful data transfer,


If you are not already set up for automated file transfer with Availity, contact Ankota. 


Manual Upload Availity Claims Management

Billing/Preparing the Availity 837

Customers can alternately manually upload their 837 files to Availity, and manually review response files in Availity.


Uploading Files in Availity Manually

To upload your Availity claims,


If the process above does not match your screen, try clicking EDI File Management --> Send and Receive EDI Files to get to the screen with the Send/Receive file folders. Alternately, check out Availity's walkthrough here.


Once files are uploaded in Availity, you will need to wait for response files.


Reviewing Files in Availity

To review your Availity claims responses, you can click the Received folder, then sort by Date so that the most recent response files are at the top. Then open the appropriate corresponding files. Typically, there are several corresponding files, one of which states in plain language what was accepted or rejected. 


On the other hand, if you use the 999 file, the data is coded. The IK5 and AK9 segments are the key there to understanding what was accepted rejected. Any time there are IK3 or IK4 segments in the 999, there is an error in the file. Segments are parts of the loop, indicated by tildes (~). Elements are parts of the segment, indicated by asterisks (*).


For example, 


The Accepted/Rejected/Error (A,R,E) data is also listed on the IK5 line.


Error codes for AK9:


The AK1 and AK2 segments describe which 837 transaction failed. The IK3 and IK4 segments describe the incorrect data in the 837 transaction.


For IK3,


IK3 errors include:


IK4 errors include:


IK5 errors include:


If you have a direct portal to the MCO, we encourage you to check the information directly with the MCO.


Remittance Advice (835s)

835s are provided in response to some claims to Availity clients, depending on your relationship to the payer. If you do receive an 835, you may upload it as usual


999s

Here is more information on 999 Rejections:

Submission InformationIK3 ErrorIK4 ErrorErrorError resolution
N3*~IK3*N3*17*2310*8IK4*1*166*1N3: AddressStreet address must be submitted
N4*~IK3*N4*18*2310*8IK4*1*19*1N4: City, State and Zip CodeThe city, state and a valid 9 digit postal Zip code must be submitted
 IK3*REF*30*2300*I6 Missing Ref segmentA ref segment with the Payer Claim Control Number is required when ClM05-3 indicates this claim is a replacement or void to a previously adjudicated claim Note (Part A and HHH only)
NM1*82*1*SMITH*MaryA R ****XX*1111111111IK3*NM1*538*2310*8~IK4*4*1036*7NM1: Rendering Provider name segmentThe trailing space after the provider name must be removed
NM1*IL*1*SMITH*JOHN*R***MI~IK3*NM1*886*2330*8IK4*9*67*1Identification Code is missingThe Subscribers Identification number must be submitted


IK301: Segment ID
IK302: Segment count of this data segment beginning with ST
IK303: Loop Identifier Code
IK304: Segment Syntax Error Code
IK401: Position in the segment
IK403: Data element syntax error code
IK404: Copy of the bad data


Troubleshooting

If you successfully upload an Availity file and get an error response in Availity, view the error, make the correction and re-upload the Merged Health Care Claim (837) as needed.


If you upload a file and it does NOT show up in Availity, there is a strong possibility you have either a) uploaded the file to the wrong location or b) have a bad character error. Assuming you are uploading to the correct location, you will want to review your data as follows.


To troubleshoot,


If one or both files uploaded successfully, then your settings are correct and you most likely have a data entry error on one client. Upload individual client Merged Health Care Claim files (837s) until you find the client that will not successfully upload.


When you have found the client in error, review their profile. Do they have a correct Medicaid ID, authorization, etc.? Is their name, primary diagnosis code, or another key piece of data appear entered incorrectly?


If you find the issue, simply correct it, then export a new Merged Health Care Claim, then upload it.


If you cannot find the issue, reach out to Availity, or alternately, Ankota Support.


For Availity support calls, please be prepared with: