Coverage profile
How Substrate can help you with Avera Health Plans
Substrate can help practices and billers with the following claims tasks for Avera Health Plans.
Claim status
EDI 276/277The Substrate Claim Status Agent can check clearinghouse claim status for your practice with Avera Health Plans.
Eligibility
EDI 270/271The Substrate Eligibility Agent can verify patient benefits, identify TPAs and carve-outs, and more with Avera Health Plans.
Portal claim status
Browser automationThe Substrate Claim Status Agent can check claim status via the payer portal for Avera Health Plans.
Frequently asked questions
Avera Health Plans payer FAQs
How do I check claim status with Avera Health Plans?
Providers check Avera Health Plans via EDI 276/277 when the payer ID is accepted. Substrate automates claim status across 3,500+ payers.
Can I automate Avera Health Plans portal follow-up?
Yes — portal retrieval is required when 276/277 is missing or stale. See payer portal automation and learn why 276/277 is not enough.
What is the payer ID for Avera Health Plans?
The primary payer ID for Avera Health Plans is 10869. The correct routing ID can differ by clearinghouse and transaction, so compare the 837P, 837I, 835, 270, and 276 entries before submitting.
What is the provider portal for Avera Health Plans?
The provider portal for Avera Health Plans is https://apps.availity.com/. Available features depend on the payer and your account.
What are the 837 payer IDs for Avera Health Plans?
The 837P and 837I payer ID for Avera Health Plans is 10869 via Stedi.
What is the 835 payer ID for Avera Health Plans?
The 835 payer ID for Avera Health Plans is 10869 via Stedi.
What is the 270 payer ID for Avera Health Plans?
The 270 payer IDs for Avera Health Plans are 10869 via Stedi and 10869 via Availity.
What is the 276 payer ID for Avera Health Plans?
The 276 payer IDs for Avera Health Plans are 10869 via Stedi and 10869 via Availity.
What states does Avera Health Plans operate in?
Avera Health Plans operates in IA, NE, and SD.
Routing reference
Avera Health Plans payer IDs and operating states
Use the payer ID listed for the transaction you are submitting. Verify current routing and enrollment requirements with your clearinghouse.
| Payer name | Avera Health PlansSource: Substrate payer directory · last refreshed |
|---|---|
| Operating states | IA, NE, SDSource: Substrate payer directory · last refreshed |
| 837P professional claims payer IDStedi | 10869Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 837I institutional claims payer IDStedi | 10869Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 835 ERA payer IDStedi | 10869Enrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDStedi | 10869Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDAvaility | 10869Source: Availity payer catalog · catalog dated · matched by payer ID |
| 276 claim status payer IDStedi | 10869Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 276 claim status payer IDAvaility | 10869Source: Availity payer catalog · catalog dated · matched by payer ID |
Routing sources and verification
- Substrate payer directoryPayer identity, aliases, operating states, and vendor IDs. Last refreshed .Open payer website ↗
- Stedi payer catalogMatched by payer ID; matched record: Avera Health Plans. Source dated .PrimaryPayerId is used as the transaction payer ID when the corresponding Stedi support flag is true.Open current Stedi reference ↗
- Availity payer catalogMatched by payer ID; matched record: AVERA HEALTH PLANS. Source dated .The attached API workbook supplies 270 and 276 payer IDs only. It does not supply 837P, 837I, or 835 IDs.Open current Availity reference ↗
- United Clearinghouse payer catalogMatched by payer name; matched record: Avera Health Plans. The source did not provide a publication date.The attachment supplies payer names and states only; it does not contain transaction-specific payer IDs.Open current United Clearinghouse reference ↗
Clearinghouse payer IDs are transaction-specific and can change. Confirm the current payer list and the member’s ID card before submission.
Payer contact directory
Avera Health Plans phone and fax numbers
Use the number associated with your task. These contacts were stated in successful eligibility responses and may apply to specific benefits, products, or departments.
- Payer phone
- (605) 322-4500Avera Health Plans, Inc.
| Channel and number | Payer Notes | Department | Specialties |
|---|---|---|---|
| phone(877) 908-8431 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(605) 322-4500 |
|
Phone and fax numbers sourced directly from the payer response
Other aliases
Also known as
- 10869
- 1786
- 46045
- 7120
- 8561
- AH002
- Dakotacare
- First Choice Health
- AVERAHP
- AETNA (COMMERCIAL & MEDICARE)