Claims submissions and disputes
Providers may enter all claims submissions and requests through Availity Essentials or using electronic data interchange (EDI) for a centralized and easy-to-use experience.
Submitting claims through EDI
Providers may submit claims, eligibility inquiries, claim status inquiries, and associated attachments using electronic data interchange (EDI) through an authorized trading partner.
EDI lets you:
- Process claims faster by submitting coordination of benefits electronically and fixing errors early with in-system notification and correction
- Reduce overhead and administrative costs by eliminating paper claim submissions
Note: All electronic data interchange (EDI) transmissions for Ohio Medicaid Managed Care membership must be submitted to the Ohio Department of Medicaid (ODM).
Submit and check authorization and claims status through Availity* Essentials
Anthem Blue Cross and Blue Shield (Anthem) uses Availity Essentials, a secure, full-service website that allows providers to submit, view, and check authorization and claims status, submit a claim dispute, and clinical appeals.
Don’t have an Availity Essentials account?
Finding claims tools on Availity Essentials
Claims status inquiry:
- From the Availity Essentials home page, select Claims & Payments from the top navigation.
- Select Claim Status Inquiry from the drop-down menu.
Claims dispute
To check claims status or dispute a claim:
- From the Availity Essentials home page, select Claims & Payments from the top navigation.
- Select Claim Status Inquiry from the drop-down menu.
- Submit an inquiry and review the Claims Status Detail page.
- To escalate, dispute, or appeal a claim, follow the steps in this document: Claims Escalation, Disputes, and Appeals Process .
Clear Claims Connection
To use Clear Claims Connection:
- From the Availity Essentials home page, select Payer Spaces from the top navigation.
- Select the health plan.
- From the Payer Spaces home page, select the Applications tab.
- Select the Clear Claims Connection tile.
To learn more about the services Availity Essentials offers to our providers, visit our Learn about Availity page.
Providers claim dispute process
Providers who disagree with the outcome of a claim can dispute that outcome when the claim is finalized. The payment dispute process consists of two steps. Providers will not be penalized for filing a claim payment dispute:
- Submit a first-level claim payment dispute. This is the provider’s initial request for a review into the outcome of a claim once it is finalized.
- Submit a second-level claim payment appeal. If a provider disagrees with the outcome of the claim payment dispute, providers may request a second-level review, also known as a claim payment appeal.
Both steps can be done via Availity Essentials, fax, or mail. They can also be submitted verbally through Provider Services. For more information regarding the claim payment dispute process, please refer to the document Claims Escalation, Disputes, and Appeals Process .
Related resources
Provider tools & resources
- Log in to Availity Essentials
- Launch Provider Learning Hub Now
- Learn about Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Member Eligibility & Pharmacy Overview
- Provider Manuals and Guides
- Provider Search Tool
- Forms
- Training Academy
- Pharmacy Information
- Electronic Data Interchange (EDI)