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Information for New York

Electronic Data Interchange (EDI)

Empire has a strategic relationship with Availity to serve as our Electronic Data Interchange (EDI) partner for all electronic data and transactions. Health care professionals, billing services and clearinghouses who are new to the EDI space can register to exchange 27x self-service and 837 claims electronic transactions with Empire in Availity.

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Don't have an Availity account? You can register here.

Who is Availity?

You may know Availity as a web portal or claims clearinghouse, but they are much more. Availity is also an intelligent EDI Gateway for multiple payers, and will be the single EDI connection for Empire and its affiliates.

Your organization can submit and receive the following transactions through Availity's EDI Gateway:

  • 837 - Institutional Claims
  • 837 - Professional Claims
  • 837 - Dental Claims
  • 835 - Electronic Remittance Advice
  • 275 - Electronic Medical Attachments
  • 276/277 - Claim Status
  • 278 - Authorizations/Referrals
  • 270/271 - Eligibility Request

Please note: All trading partners must use the Availity EDI Gateway to submit Empire EDI transactions. The EDI gateway migration does not impact participation status with Empire or how Empire adjudicates claims.

Getting Started with Availity

Availity setup is easy! Get directions and information you need to start exchanging direct EDI transmissions on the Availity EDI Gateway.

Learn More

Questions?

For questions, call Availity Client Services at 1-800-Availity (1-800-282-4548). Availity Client Services is available Monday - Friday 8 a.m. - 8 p.m. ET.

Companion Guide

The companion guide provides supplemental instructions for EDI transmissions specific to Empire.  All new submitters will use the Availity EDI Gateway for their Empire EDI transactions.

Review the Guide

EDI Resources

  • Payer Codes

  • Electronic Funds Transfer

  • Electronic Remittance Advice

  • HIPAA Resources

Payer Codes

Availity provides a searchable listing of payer codes. Providers can search based on state, payer type, transaction type and submission mode.

Availity Payer List

Electronic Funds Transfer (EFT)

Electronic claims payment through electronic funds transfer (EFT) is a secure and fastest way to receive payment reducing administrative processes. EFT deposit is assigned a trace number that is matched to the 835 Electronic Remittance Advice (ERA) for simple payment reconciliation.

Use EnrollSafe (https://enrollsafe.payeehub.org/) to register and manage EFT account changes.

Electronic Remittance Advice

If you wish to receive direct 835’s, use Availity to register or make changes to your Empire (835) Electronic Remittance Advice profile.

If your organization uses a vendor or clearinghouse, please work directly with them to complete your ERA registrations or to facilitate changes.

1) After you complete the Electronic Remittance Advice (835) setup, follow the below steps:
 
Contact your financial institution to arrange for the delivery of the CCD+ Data Elements necessary to re-associate your EFT payment with the remittance advice.
 
The required fields are listed below. 
 
  • Effective Entry Date
  • Amount
  • Payment Related Information
2) For assistance with a missing or late Electronic Remittance Advice (835), please contact Availity Client Services at 1-800-282-4548.
 

Medicare Crossovers
To enroll in (835) Electronic Remittance Advice for Blue Cross and Blue Shield plans other than Empire, please contact 800-470-9630.
(This occurs when Medicare is primary and the secondary payer is a Non-Empire Blue Cross Blue Shield plan)

 

HIPAA Resources

Washington Publishing Company
EDI- and HIPAA-related publications and tools

National Council for Prescription Drug Programs
ANSI-accredited organization that creates standards for electronic health care transactions

National Committee on Vital & Health Statistics
Advisory body to the Secretary of Health and Human Services for health data and privacy

Ready to become a provider in the Empire network?

We look forward to working with you to provide quality service for our members.

Payments for services from a non-participating provider are generally sent to the member, except where federal or state mandates apply, or negotiated agreements are in place.
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