Supported EDI transactions

Availity is operationally HIPAA compliant, securely accepting and processing a number of X12N transactions mandated by the Health Insurance Portability and Accountability Act (HIPAA). The table below provides information about the ANSI ASC X12N health care electronic transactions adopted for use by the HIPAA regulations, and supported by the Availity Health Information Network.

Table 1. Supported transaction formats
Format Version supported Transaction type Optimal batch file
ASC X12N 837 005010X223A2 Institutional Claims 5,000 claims or 4 megabytes
ASC X12N 837 005010X222A1 Professional Claims 5,000 claims or 4 megabytes
ASC X12N 837 005010X224A2 Dental Claims 5,000 claims or 4 megabytes
ASC X12N 270/271 005010X279A1 Health Care Benefit Inquiry/Response (Eligibility and Benefits) 4 megabytes
ASC X12N 276/277 005010X212 Health Care Claim Status Request/Response 4 megabytes
ASC X12N 278 005010X217 Health Care Services Request (Authorization and Referral) for Review/Response 4 megabytes
ASC X12N 278 005010X216 Health Care Services Review Notification and Acknowledgement 4 megabytes
ASC X12N 835 005010X221A1 Health Care Claim Payment/Advice (ERA) 4 megabytes
ASC X12N 275 005010X210 Additional Information to Support a Health Care Claim or Encounter (275) 40 megabytes max per attachment and 80 megabytes max per batch
Note: For the ASC X12N 835 format, files over 12 megabytes with large checks might not be validated.
The Availity HIPAA validation is based on the HIPAA-mandated implementation guides. For information about HIPAA edits, please refer to the appropriate HIPAA Implementation Guide for the transaction you are submitting.

  • For a cost, you can obtain the appropriate HIPAA Implementation Guide from x12.org. Choose the implementation guide that best suits your business needs.

  • You might want to validate or certify your transactions prior to submitting them to Availity. This service is offered over the internet by various vendors.

    Tip: Search on free HIPAA validator, in a search engine, for a list of sites that might be offering HIPAA validators.