AvMed Health Plans offers full support for all HIPAA mandated transactions.

[EDI (Electronic Claims Submission)] The AvMed Health Plans Electronic Data Interchange service will be the method for exchanging electronic data with our Trading Partners.

The EDI Service will receive and deliver transaction data (claims, claim status, remittances, etc.) between AvMed Health Plans and its Trading Partners. To AvMed a Trading Partner is any external organization, physician or hospital that transacts business in our electronic environment.

Resources:

CAQH/CORE
CMS
WPC
AvMed remit codes explanations

AvMed Claim status codes used

5010 Transactions

AvMed's real-time based eligibility, benefits and claim status application follows the standard operating rules defined by Phase I and Phase II of the CAQH/CORE requirements. For further information on how to use the new application, please see the 270/271 and 276/277 Companion Guides
5010 Transactions
Transaction
Description
Companion Guide

NOTE: To see the other 5010 transactions available see Contact Us.

270/271
Eligibility Request and Response
276/277
Claim status Request and Response

Regular Scheduled Maintenance
The real-time transactions may not be available due to regular system maintenance during the following times:

  • Every Sunday 8:00 PM - 9:00 PM (Eastern Time)

Unscheduled Maintenance or Emergency Downtime

  • None at this time

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