AvMed is upgrading its systems to simplify processes, expand resources, and create a stronger foundation for future improvements. These enhancements will help us better support our Providers, serve our Members, and deliver on our mission: We improve health every day. 

New Portal Experience - Availity Essentials is a multi-payer portal where Providers can check eligibility and benefits, manage claims, and more to streamline their work. Many of our Providers are already using Availity with other payers that they are contracted with and are familiar with its ease of use. 

Payments - AvMed is moving to Zelis Payments, a trusted leader in healthcare payments dedicated to delivering value through quality services and technology. Zelis offers complete transparency and easy access to payment and remittance data in one user-friendly experience.

Your central source for Availity, Zelis, Claims, and Authorizations updates.

Availity Essential Provider Quick Guide

AvMed Zelis Provider Quick Guide

AvMed & Availity Provider Webinar Training Schedule

 

Claims Split Bill Logic

Claim Type DOS Range Billing Requirement Notes
Claim TypeUB-04 - InpatientDOS RangeAdmit before 1/1/2026 and spans into 2026Billing RequirementNo split billing requiredNotesSubmit as a single claim
Claim TypeUB-04 - Non-InpatientDOS RangeFrom DOS in 2025 and to DOS in 2026Billing RequirementSplit billing required by calendar yearNotesSubmit separate claims for 2025 and 2026 DOS
Claim TypeHCFA-1500DOS RangeFrom DOS in 2025 and to DOS in 2026Billing RequirementSplit billing required by calendar yearNotesSubmit separate claims for 2205 and 2026 DOS

Availity Frequently Asked Questions

If you are already working in the Availity Essentials portal, the same user ID and password can be used to sign in to the Essentials account for AvMed. For a refresher, please visit Availity’s Reference Guide for Admins and Reference Guide for Users.
For providers new to Availity Essentials, the Get Started page has an abundance of resources, and a link to register. Once an Availity Essentials account has been created, navigate to the "Help and Training" button in the upper right corner of the home screen, then select "Get Trained" for additional training options.
  • Access AvMed Payer Space to obtain information and access to AvMed-specific applications and resources
  • Check Eligibility & Benefits
  • View and Print Member ID Cards
  • Submit claims using Availity’s data entry inputs
  • Check Claim Status
  • View Remittances
  • Submit Authorization Requests
  • Obtain statuses of Authorization Requests
  • Submit Authorization Attachment
  • Check the Authorization and Referral Dashboard

To access applications in Availity Essentials, you will need specific role(s) assigned to your user accounts.  For the features currently available in Availity you will need the following roles:

  • Eligibility & Benefit application - Eligibility & Benefits role
  • Claim application - Claim Role
  • Remittance Viewer - Claim Status Role
  • Authorization & Referrals - Authorization and Referrals role
The Availity Administrator in your organization assigns roles and permissions. If you are missing a role or do not have access to one of the applications, reach out to the Availity administrator within your organization.
You can locate the organization’s Availity Administrator by navigating to [Your Name's] Account at the top of the Availity Essentials home page. Select My Account | Organization(s) | Open My Administrators.
The 2 roles have different permissions and functions. Administrator role has access to most administrator related functions and is responsible for managing and maintaining the users in the organization and generating reports. The Administrator Assistant has the ability to edit Manage My Organization but does not have access to Administrative reports.
Yes, providers can obtain Eligibility and Benefit information for members coverage both prior to January 1, 2026 and after. Eligibility and Benefit information will go back 12 months from the date of the request.

No, providers can only send an Authorization or Referral request utilizing Availity’s Essential Portal for dates of service January 1, 2026 or after.

Authorizations and Referrals requests and status for dates of service prior to January 1, 2026 providers must utilize the legacy AvMed Portal. Log In Here.

No, at this time only requests that were submitted through Availity’s Essential Portal will be available to obtain status or appear on the Authorization & Referral Dashboard.
Providers must consult the Prior Authorization Look-up (PAL) Tool and enter the requested information to determine if an Authorization is required. View the PAL tool.
No, Authorizations issued by our UM delegates will continue to be housed in their internal systems. Providers can access our UM delegate vendor’s portal for authorization requests and status from our Availity Payer Space Application tab. UM delegate vendors include:
• EviCore
• IHCS
• Optum Behavioral/Optum Transplant
Only certain Specialties require referrals. If a provider selects to Retrieve Provider Info during the Service Provider entry for an NPI of a rendering provider with a provider’s specialty that does not require a referral, a message will be presented indicating Referral is not required for this service.
No, only the Primary Care Provider (PCP), who is on record for the member can request a referral.
No, the servicing provider must be participating for the member.
Referrals are good for 180 days, plus the additional 5-days retro period added to the referral upon extract to JIVA.
Yes, providers can submit claims utilizing the Claim & Encounter feature under the Claims & Payments menu for dates of service both pre and post January 1, 2026. Please note for Outpatient and Professional claims do not include dates of service that span the calendar year in one claim.
No, not at this time. Claim attachments can either be mailed or faxed in. The provider can indicate how they plan to send attachments in the Availity Essentials Claim Submission module by selecting the appropriate Report Transmission Code under Add Additional Claim Information/Attachments. Also, please indicate the Claim Number on the attachment for faster processing.
Providers can obtain claim status on claims going back 12 months from the date of the request.
Yes, you can obtain a claim status for claims prior to January 1, 2026 in Availity’s Essential Portal, if you enter in the Claim Number or Claim Amount in addition to the required fields indicated with a red asterisk (*).
Yes, Remittances with a paid date of January 1, 2025 and after will be available in Availity Essential Portal.

Additional details for claims are available via the Remittance. You can obtain Remittances in Availity in two ways.

Option 1: Within the Claim Status response there will be a button at the top right side of the page entitled “Remittance Viewer.” Click on that and you will be taken directly to the Remittance that corresponds to that Claim.
Option 2: A provider can also go to the Claims and Payments section on their Home page and select Remittance Viewer. You can locate the remittance by searching for the claim id (or clicking from the Check/EFT tab to view claims included within the Check/EFT). Please note that these details are only applicable to remits for Check Dates beginning 1/1/2025 and newer. The provider can then click on the claim number hyperlink and view further details.

Zelis Frequently Asked Questions

AvMed is partnering with Zelis to deliver claim payments and remittances. Providers will transition from ECHO/Change Healthcare processes to Zelis. If you’re already enrolled with Zelis, you do not need to re‑enroll to continue receiving electronic payments.
The Zelis Provider Portal is a single site where you can view payment history by claim, download EOP/ERAs (835/CSV/XLS/PDF), set notifications, and manage users across many payers with one login. Visit the Zelis Provider Portal (Chrome recommended).

To Enroll in ACH+ or Virtual Credit Card (through ZPN):
1) Log in to the Zelis Provider Portal → Settings → Payment Method.
2) Select ACH+ Direct Deposit or Virtual Credit Card and complete identity/banking verification (Authorized Decision Maker may be required).
3) Allow time for verification; banking changes can take up to 10 business days.
Support: 877‑828‑8770 (portal support) | Enrollment: 855‑496‑1571.

To Enroll in No‑cost Standard ACH (through AvMed ePayment Center):
1) Use the AvMed ePayment Center (EPC) registration link provided in our communications. http://avmed.epayment.center/avmed.epayment.center/Registration
2) Enter business details, bank account, ERA preferences, and notifications; sign the ACH agreement.
3) Bank pre‑note validation may take ~6 business days before deposits begin.
Support: 855‑774‑4392 | help@epayment.center

If you are already enrolled with Zelis: No action required—your AvMed payments will follow your current Zelis method (ACH+ or VCC).
If no enrollment, checks will continue.

For ZPN (multi‑payer ACH+/VCC)
Call: 855‑496‑1571
Visit: ZPN Portal

For EPC (AvMed‑only ACH)
Call: 855‑774‑4392
Email: help@epayment.center

Payment options at a glance

Method  ACH + (ZPN) Standard ACH (EPC)   Virtual Credit Card (VCC) Paper Check 
MethodWhat It Is  ACH + (ZPN)

Direct deposit with enhanced features and consolidated payments via Zelis

Standard ACH (EPC) No‑cost ACH for AvMed payments only via ePayment Center Virtual Credit Card (VCC)Single‑use card number; payment via card terminal/processorPaper Check Mailed check with EOP
MethodCost to Provider  ACH + (ZPN)Provider fee (varies)Standard ACH (EPC) No provider fee (payer‑sponsored)
 Virtual Credit Card (VCC)Merchant card fees apply
Paper Check No provider fee, but higher admin cost/time
MethodPayers Covered ACH + (ZPN)Many payers (multi‑payer)
Standard ACH (EPC)  AvMed only Virtual Credit Card (VCC)Many payers (multi‑payer)
Paper Check All when selected
MethodHow You Access It  ACH + (ZPN)Zelis Provider PortalStandard ACH (EPC) AvMed ePayment Center
(separate login)
 Virtual Credit Card (VCC)Zelis Provider Portal (or fax/mail delivery)
Paper Check Mail; details also visible in portal
MethodPros ACH + (ZPN)Faster funds, one login, robust reporting & 835 delivery, centralized support
Standard ACH (EPC) No fee, direct deposit, 835 available
 Virtual Credit Card (VCC)Access funds quickly; no bank setup needed
Paper Check No banking setup required
MethodConsiderations ACH + (ZPN)Provider fee: bank change verification may take up to ~10 business days
Standard ACH (EPC) Separate portal; covers only AvMed; pre‑note bank validation may take ~6 business days
 Virtual Credit Card (VCC)Transaction fees: must be processed like a card payment
Paper Check Slowest; risk of mail delays/loss; manual posting

ERAs (835s) and data delivery 

• Zelis portal: Download EOPs/ERAs and export data in 835/CSV/XLS/PDF; route 835s to clearinghouse or SFTP.
• EPC: Download ERAs/835 for AvMed payments; configure delivery preferences during enrollment.

 

• Zelis Provider Portal (Chrome recommended).
• AvMed ePayment Center: Payer‑specific EPC URL provided during enrollment.

Browser & Access Tips
Use the latest Google Chrome on desktop. Allow pop‑ups. If you run into issues, clear cache/cookies and retry. Mobile or iOS Safari may not be supported for some features.

Notifications
Enable email/SMS notifications in the portal(s) so you know when payments and files are ready. Fax notifications are available for certain delivery types.

Consolidation & Reconciliation
Zelis offers consolidated payments and a single support channel across payers, which reduces manual check handling and improves posting. Portal views include filters (e.g., Not Downloaded) and statuses (e.g., Deposited for ACH+/VCC). Unclaimed funds (e.g., stale checks) are handled per escheatment rules.

Coming from ECHO/Change Healthcare
Prior AvMed workflows via ECHO/Change Healthcare are being replaced. If you previously received EFT through ECHO, select an equivalent Zelis option—ACH+ (ZPN) or no‑cost ACH via EPC—to continue receiving electronic payments. Transition communications will include any action items specific to your TIN(s).

Support & Contacts
• Zelis Enrollment (ACH+/VCC): 855‑496‑1571
• Zelis Portal Support: 877‑828‑8770
• AvMed ePayment Center (EPC) Support: 855‑774‑4392 | help@epayment.center