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  • Change Request Form Organization Maintenance - Availity

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Change Request Form Organization Maintenance Rev. 09.04.2014.1 ORGANIZATION INFORMATION (all fields required as currently on record with Availity) Organization Name: Customer ID: City: State: Primary.

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Secondary – If you have already submitted a primary claim and want to submit a secondary claim, select Secondary in the Responsibility Sequence field. Enter the secondary information on the page. You must also enter the primary information from the 835.

TYPE 2 NPI: If a physician or medical provider is part of a clinic = o Physician must use the rendering NPI number (Type 1) rather than the billing clinic NPI number. o Facilities must use the "Type 2" NPI number. Note: Please continue to use the billing NPI for BCBSTX claim status transactions through Availity.

Availity portal corrected claim submission In the Availity portal menu, select Claims & Payments, and then select ProfessionalClaim or Facility Claim, depending on which type of claim you want to correct.

Intelligent Eligibility You can also check coverage information across multiple payers, including Medicaid MCOs, Medicare secondary payer information, participation in Medicare Part C/Advantage plans, gaps in coverage, restricted coverages, and more.

Go to Account Administration | Maintain Organization, and enter the new tax ID in the Tax ID field on the Organization Information page.

To associate additional providers to your organization for express entry on transactions, go to My Account |Manage Providers in Availity. To change your organization type with Availity, select a new organization type from the field below.

On the Availity home page, click GET STARTED. 3. On the page that displays, click Start Registration to begin the wizard. To quickly complete the registration, we recommend having your organization name and contact information, tax ID, and NPI available.

For 20 years, provider organizations, health systems, and vendors have trusted Availity to process healthcare transactions quickly and accurately. Our EDI Clearinghouse solution lets you can connect to more than 2,000 payers nationwide, including government payers like Medicaid and Medicare.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232