Avera Health Plans
Part of Avera Health
Summary
Avera Health Plans is a regional health plan, part of Avera Health, offering dental and medical coverage operating in 5 states. Claims route under payer ID 10869, with 5 alternate IDs in use across clearinghouses. Provider enrollment typically takes 60-90 days, with applications through Avera Health Plans Provider Portal, and CAQH is used for credentialing data. Through clearinghouses it supports eligibility checks, claim status inquiries, professional claims, institutional claims, and electronic remittance (ERA); ERA enrollment is required and takes several weeks.
At a glance
- Payer ID
10869Also seen as 1786, 46045, 7120, 8561, AH002- Also known as
- First Choice Health
- Uses CAQH
- YesApplication route: CAQH application only
- Service area
- SD, IA, NE, MN, ND
Clearinghouse transaction setup
Which EDI transactions this payer supports, and how long clearinghouse enrollment typically takes when it is required.
| Transaction | Enrollment | Typical setup |
|---|---|---|
| Eligibility checks (270/271) | Not required | Immediate |
| Claim status (276/277) | Not required | Immediate |
| Professional claims (837P) | Not required | Immediate |
| Institutional claims (837I) | Not required | Immediate |
| ERA / remittance (835) | Required | Several weeks |
Common questions
- What is the payer ID for Avera Health Plans?
- The payer ID for Avera Health Plans is 10869. Alternate IDs seen across clearinghouses include 1786, 46045, 7120, 8561.
- How long does Avera Health Plans provider enrollment take?
- Avera Health Plans provider enrollment typically takes 60-90 days from application to effective date. Timelines vary by state, plan, and how complete the application is.
- Does Avera Health Plans require CAQH?
- Yes. Avera Health Plans uses CAQH for credentialing data, so keep the provider's CAQH profile current and attested before applying.
- Does Avera Health Plans require ERA enrollment?
- Yes. Avera Health Plans requires a separate ERA (835) enrollment before electronic remittances flow, and setup typically takes several weeks.
- What states does Avera Health Plans cover?
- Avera Health Plans operates in SD, IA, NE, MN, ND. Coverage can differ by plan and product line, so confirm the specific plan before you file.
Compiled from public payer resources and clearinghouse catalogs. Details change often, so confirm with the payer before relying on them. Spot something out of date? Tell us and we will fix it.