Availity Essentials single claim submission response reports

Does your organization submit single claim submissions online to Availity Essentials? This feature is a no-cost option to submit your claims, but like all claim submissions, it’s important to review the response reports to ensure your claim has been accepted.

How do I view my response reports?

Your organization’s Availity administrator will need to assign the electronic data interchange (EDI) management role to users who submit online claim submissions. Even though the claims are submitted without using EDI software or a vendor, online claim submissions are still considered EDI transactions that will create response reports.

Once the role has been assigned, the user will have access to the EDI clearinghouse menu located under the Claims & Payments menu. The three tiles used are listed below:

• Send and receive EDI files — The response files will be in the receive folder.
• File restore — Availity will archive your response files after 60 days; use this option to restore your reports.
• EDI reporting preferences — Select text > Human readable format. The other formats are only used for EDI software.

What kind of response reports do I need to view?

• File acknowledgments — Shows your claim has been received.
• Immediate batch response — Acknowledges accepted claim and identifies if rejected due to HIPAA and/or payer-specific edits.
• Delayed payer reports — Certain policies will go through a second level of editing for the payer; This report will return if that is the case.

We are here to help

Availity Essentials offers on-demand recorded training and documentation to assist with reviewing your response reports:

• Log in to Availity Essentials and select Help & Training > Get Trained.
• Use the catalog filter and select EDI Clearinghouse; several courses will display for you to enroll in and view.
• Use the EDI Companion Document to view the Setup EDI Reporting Preferences Chapter.
• Contact Availity Client Services at 800-282-4548 Monday through Friday from 8 a.m. until 8 p.m.