Eligibility
Review the patient, payer and service-date inputs for the supported eligibility route. Resolve rejected inquiries and changed coverage before using the response in the next step.
Review eligibility verificationClearinghouse workflow guide
Availity workflows with QuickRCM
Map eligibility, claims and remittance handoffs before relying on a connection. Start with your organization’s payer enrollment, access and transaction requirements, then verify the workflow with your implementation team.
Source comparison prepared . Reviewer sign-off pending. Sources: QuickRCM training manual, sections 01 Eligibility, 05 Claims, 08 Payment Posting and 11 Appeals.
Follow each handoff
These workflow references describe the QuickRCM process. Available routes depend on the payer, transaction and organization configuration. Confirm those details before sending data or changing a submission route.
Claims
Confirm the payer and clearinghouse route before submission. Retain the acknowledgment and tracking context; a transmitted claim still needs payer follow-through.
Review claims workflowsERA and payment posting
Follow an 835 remittance from receipt into matching, adjustments and exception review. Keep deposit reconciliation, posting and any EHR ledger update distinct.
Review payment postingDenials and appeals
Carry the claim, payer response and supporting documents into review. Confirm payer-specific attachment and appeal channels, then record the actual submission and response.
Review denial managementDefine the connection scope
- Confirm enrollment and access. Identify the organization, payer, transaction types and staff permissions. Confirm vendor access and any payer enrollment before testing.
- Map the handoff. Agree which system supplies the inputs, receives the response and owns exceptions. For remittances, separate file receipt, matching, posting and ledger write-back.
- Exercise supported and rejected paths. Review acknowledgments, missing information, unavailable routes and duplicate-submission handling with the responsible team.
- Record acceptance and follow-up. Keep the tested payer and transaction scope, observed results and responsible owner. Expand scope only after reviewing the additional path.
Confirm your own configuration and required agreements. This guide does not establish a vendor partnership, certification, deployment timetable or payer-wide availability.
Workflow questions
Does this page confirm that my Availity connection is active?
Confirm your organization’s access, payer enrollment and supported transactions with your implementation team. A workflow reference does not confirm an active connection, vendor partnership or support for every payer.
How does an ERA reach payment posting?
For a configured payer and remittance feed, the 835 ERA enters the payment-posting workflow. Staff review unmatched items, adjustments and exceptions before the appropriate downstream handoff. Receiving an ERA is separate from confirming the bank deposit or a completed ledger update.
Can a different clearinghouse or external submission be used?
Routing depends on payer capabilities and the organization’s configuration. The QuickRCM workflow includes Availity and Stedi paths; staff should confirm the supported route before retrying or using an external submission. Keep the prior receipt and check status to avoid duplicate work.
Are attachments and appeals available for every payer?
Payer support and submission requirements vary. Verify the recipient, supported channel and required documents before submission. When an external route is needed, record the submission and confirmation in the case workflow.