Receiving payment

Professional reimbursement

Learn about our professional reimbursement methodology.

Overpayment recovery

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

Pricing disputes and appeals

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

Provider payment information

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

Other payment information

View procedures not covered and the responsibilities of participating providers.

Provider audits

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

ANSI 835 Electronic remittance advice

We provide claims processing information in an ANSI 835 Electronic Remittance Advice (835 ERA) format.

You can use the options below to obtain your claims payment information. Enrollment is quick and easy and there is no cost to you.

  • View claims payment information online in human-readable format using Availity's Remittance Viewer.
  • Receive your remittance advice electronically via an ANSI 835 ERA. Enrollment is quick and easy and there is no cost to you.


Receive your claims processing information for your Asuris patients via an 835 ERA.

Enroll using Availity Essentials: My Providers>Enrollments Center>Transaction Enrollment.

835 codes

We use Group Code "PI" (Payer Initiated Reductions) and do not use Group Code "OA" (Other Adjustment) except for the codes indicated on the Claim Adjustment Reason Codes list. View the list on the wpc-edi website. View the Explanation Code (EXCD) ANSI code crosswalk document.

Electronic funds transfer (EFT)

Claim payments via EFT is a requirement for participation in our networks. In addition, we require all provider claims to be submitted electronically. If you’re not already receiving payments via EFT, please register now.

To register for EFT

Receive fast, secure delivery of your claim's payments, use Availity's Transaction Enrollment Tool.

The Transaction Enrollment Tool is available on the main menu of Availity Essentials: My Providers>Enrollments Center> Transaction Enrollment. You can view a dashboard with updates and the status of your EFTs.


  • Medical pharmacy claims and service: Sign-up for EFT using Availity's Transaction Enrollment Tool
  • Pharmacy claims and services: Sign-up for EFT by contacting Prime Therapeutics at 1 (844) 765-6827

EFT deposits will be made two business days after the payment issue date to comply with National Automated Clearing House Association (NACHA) guidelines. Note: We will make only credit entries to your designated bank account. If it becomes necessary to initiate a correcting debit, we will notify you in advance.

Updating your EFT information

If you change bank accounts, submit a change request using Availity's Transaction Enrollment Tool.


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



Effective entry date - date the payer intends to provide funds to the payee via EFT


EFT effective date






Payment amount




Payment-related information - payment-related ASC X12 data segments

TRN02 and TRN03

EFT Trace Number and Payer Identifier

Check/EFT trace number

Prompt payment regulations

We make every effort to pay or deny clean claims within thirty (30) days of receipt. A clean claim is a claim submitted on a properly completed paper or electronic claim form that does not require any additional documentation or information to determine our liability for payment. We determine what claims do not require substantiating documentation from the provider, information from a third party, or further review to determine our liability for payment.

Some types of claims are excluded from Prompt Pay laws, depending on individual state statutes and/or federal law. The following claims are commonly excluded:

  • Pharmacy
  • Medicaid entities
  • Capitated agreements
  • Claims paid to members
  • Asuris Pledge Medigap
  • Claims paid to members
  • Medicare Advantage Plans
  • Non-participating provider claims
  • Administrative services only (ASO) groups

The Washington State Prompt Pay statute is WAC 284-43-321. Additional information regarding timely payment is available in your agreement.