What is Availity and why should I register if I'm an Out of Network provider?

Historically, Out-of-Network practitioners  have been asked to provide a W9 before their clients/patients could be reimbursed for out of network care.

More and more insurance carriers are requiring that Out-of-Network practitioners register with them in order for their members to receive out of network reimbursement. Availity can help minimize the need to register with multiple carriers, as Availity automatically sends your updates to all payers who are subscribed with them (which includes all of the major payers, and most of the medium-sized ones).

Availity's Provider Information Management platform shares data with their new credentialing app, which many payers are using to simplify the credentialing and recredentialing process for providers. The new app saves time and shows you just where your application is in the process of verification, review, and approval.

This is a multi-verification process and will need to be completed in steps. 

1. You will need to begin by creating an Availity Essentials account. Click here to open the Availity website.

When registering, you will select "I need to register a new organization and will be the primary administrator" 


2. Add your business/organization is registered. To do this, navigate to your account at the top right corner and select "Manage My Organization". From this page, select "Register an Organization" on the left. Select "None of these apply. Add New Organization" 

3. Fill out the Organization Registration with you most up to date information. If you are the practice owner, input "Owner of Private Practice/Business Owner/Founder" in the "What do you do the most" dropdown. Be sure to input you personal phone number, this is used by Availity for security and verification purposes.

4. Continue to fill out the Organization Registration. Organization name can be your business name or your 'doing business as' name. If you are unsure of your taxonomy code or if the NPI registry is not up to date with your current code, you can review a list here: https://taxonomy.nucc.org/ 

For "Does this organization have an NPI", select "This organization has an NPI". If you have an NPI2, enter it here. f you do not, enter you individual NPI number.  

5. Enter in your primary service location address on the next screen. For telehealth only, you will still need to enter in your primary address. You will want this address to match with the NPI registry.

For "Payers' Regions", list every state you are licensed to provide services. 

Do NOT check the box that reads "We need to securely exchange batches of EDI files with payers using Availity's SFTP"

6. Continue on to the personal information screen. It is important you enter your personal address and phone number, not your business address on this screen. Availity uses this information to verify identity. 

For verification option, we recommend using the last 4 digits of your social security number to expedite verification processing. 

7. Verify and submit your information for approval. 

8. Once your information has been submit to Availity, the will review and approve your registration request. This can take anywhere from 24 hours to 3 weeks. You will be notified when your registration has been approved. 

9. Once you have been notified your registration has been approved, log back into Availity and navigate to PROVIDER DATA MANAGEMENT. Select the hamburger menu next to your practice on the right and select "manage type 1 providers"

10. Select "add a type 1 provider to this business" Here you will add yourself and any other providers in your practice. You will search by individual NPI numbers. 

Do NOT check the box that reads "This provider is an atypical provider or does not qualify for a Type 1 (practitioner) NPI. 

After adding each provider, you will need to resolve the errors by completing the requested information. 

Be sure to upload licenses for each providers even if it is not displayed as an error that needs resolved. 

11. After adding all Type 1 providers, navigate to "Manage Business". Correct all error by entering in the required information. 

12. For "Payment Address", input your mailing address even if it is not your practice address. 

13. At the bottom of the "Payment Address" screen, you will need to upload a copy of your W9. 

If you do not have one, you can use our form to generate one here. 

14. Once all information has been completed, Submit your verified profile. It can take 2-3 weeks for Availity to update your profile to insurance companies.