Electronic Remittance Advice Enrollment
THIS TRANSMISSION IS A PROPRIETARY AND CONFIDENTIAL COMMUNICATION The documents accompanying this transmission may contain confidential health
information that is legally privileged. This information is intended only for the use of the individuals or entities listed above. If you are not the intended recipient, you are hereby
notified that any disclosure, copying, distribution, or action taken in reliance on the contents of these documents is strictly prohibited. If you have received this information in
error, please notify the sender immediately and arrange for the return or destruction of these documents.
The name of the payer sending/issuing the X12 835 files.
The payer’s unique identifier.
Who will receive your ERA files?
The type of organization that will receive the X12 835 files: Provider,
Clearinghouse, or Vendor.
The name of the organization that will receive the X12 835 files.
The receiving organization’s customer ID assigned by Availity. To
determine your customer ID, click Who controls my access? at the
top of any page in the Availity Web Portal.
Name of a contact at the receiving organization (if different than the
Telephone number of the receiving organization’s contact.
E-mail address of the receivng organization’s contact.
Complete legal name of institution, corporate entity, practice or
The number and street name where a person or organization can be
City associated with provider address field.
ISO 3166-2 Two Character Code associated with the
State/Province/Region of the applicable Country.
System of postal-zone codes (zip stands for "zone improvement plan")
introduced in the U.S. in 1963 to improve mail delivery and exploit
electronic reading and sorting capabilities.
Provider Federal Tax Identification
Number (TIN) or Employer Identification
A Federal Tax Identification Number, also known as an Employer
Identification Number (EIN), is used to identify a business entity.
National Provider Identifier (NPI)
A Health Insurance Portability and Accountability Act (HIPAA)
Administrative Simplification Standard. The NPI is a unique
identification number for covered healthcare providers. Covered
healthcare providers and all health plans and healthcare
clearinghouses must use the NPIs in the administrative and financial
transactions adopted under HIPAA. The NPI is a 10-position,
intelligence-free numeric identifier (10-digit number). This means that
the numbers do not carry other information about healthcare providers,
such as the state in which they live or their medical specialty. The NPI
must be used in lieu of legacy provider identifiers in the HIPAA
Name of a contact in provider office for handling ERA issues.
Associated with contact person.
An electronic mail address at which the health plan might contact the
Preference for Aggregation of
Remittance Data (e.g., Account
Number Linkage to Provider Identifier)
Provider preference for grouping (bulking) claim payment remittance
advice – must match preference for EFT payment.
Provider Tax Identification Number (TIN) – Enter a TIN in the field
provided if you select this option.
National Provider Identifier (NPI) – Enter an NPI in the field provided
if you select this option.