AvMed at a glance
| Legal name | AvMed, Inc. |
|---|---|
| Also known as | — |
| Category | Commercial |
| Parent organization | AvMed, Inc. (nonprofit) |
| Claims payer ID | 59274 — registry reference; verify the member product, transaction and clearinghouse |
| Eligibility (270/271) payer ID | 59274 — registry reference; verify the member product, transaction and clearinghouse |
| ERA (835) payer ID | 59274 — registry reference; verify the member product, transaction and clearinghouse. Not verified: Copied ERA identifier 59274 was not independently verified. The current hub directs remittance/payment access to Zelis; confirm the actual product, clearinghouse and enrollment instructions. |
| NAIC company code | Not established in this registry |
| States covered | Florida |
| Members covered | ~300k members |
| Provider resource entry point | https://www.avmed.org/en/provider/provider-implementation-hub |
| Provider phone | 1-800-452-86331-800-452-8633 is the published Provider Service Center; Zelis payment/enrollment contacts are separate. |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for AvMed
The current AvMed transition resources do not establish an initial-claim filing limit. The older 2025 reference-guide URL could not be retrieved; confirm the current product and provider agreement before relying on the registry 180-day seed.
| Submission type | Window |
|---|---|
| Initial claim reference | Confirm current product and provider agreement |
| Out-of-network initial claim | Verify the member's plan and applicable out-of-network rules |
| Secondary / coordination of benefits | Verify the allowed window and start event; a primary EOB does not automatically restart filing |
| Corrected claim | Verify correction instructions; do not substitute an appeal deadline |
| Reconsideration / appeal | Use the applicable denial or decision notice and the process below |
This registry has not established a payer-specific appeal ladder for AvMed. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
Source: AvMed provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with AvMed
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
CMS-0057-F decision-timeframe requirements and exclusions
Verify AvMed electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable. Authorization requirements and submission channels depend on the product, service and delegated reviewer. Verify the applicable policy before scheduling; a portal listing is not proof of X12 278 connectivity.
This registry does not provide a current prior-authorization code list for AvMed. Start with the provider resources or the policy documents below, then confirm the applicable product, service and effective date. A resource link does not establish that a live code-lookup tool is available.
Top denial reasons for AvMed
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient AvMed volume. Until then, see the broader CARC reference for industry-wide remediation guides.
Electronic claims, eligibility & ERA
| Transaction | Registry indication — not verification | Routing reference |
|---|---|---|
| 837P / 837I claims | Listed in registry; verify current scope | 59274 — registry reference; verify the member product, transaction and clearinghouse |
| 270 / 271 eligibility | Listed in registry; verify current scope | 59274 — registry reference; verify the member product, transaction and clearinghouse |
| 278 prior authorization | Listed in registry; verify current scope | Verify X12 278 routing separately |
| 835 ERA | Verify support and enrollment separately | 59274 — registry reference; verify the member product, transaction and clearinghouse. Not verified: Copied ERA identifier 59274 was not independently verified. The current hub directs remittance/payment access to Zelis; confirm the actual product, clearinghouse and enrollment instructions. |
Payer IDs vary by clearinghouse — confirm against your clearinghouse payer list (Availity, Change Healthcare/Optum, Waystar) before configuring submitter routing.
What revenue cycle teams should verify before submitting claims
- Claims payer ID 59274 is expressly identified for claim submission; separate transaction routing and enrollment still need verification.
- Availity supports claims across pre- and post-2026 service dates, but the publisher directs claim attachments by mail or fax. Authorization/referral requests for service before January 1, 2026 use the legacy portal.
- Zelis handles remittance/payment access. These vendor roles do not certify QuickIntell integration or a universal ERA routing identifier.
Source checks and remaining limits
The latest partial comparison is dated . Retained earlier findings keep their original dates below. This is a partial source check, not a whole-page, clinical or legal review. It does not refresh the legacy review date above.
payer_ids.claims, portal_url, provider_phone — AvMed: 2026 provider implementation hub
Source comparison: 2026-09-18
Retain claims identifier 59274 and provider phone 800-452-8633 with source scope. Current transition instructions distinguish Availity, legacy authorization requests and Zelis payment functions. Source scope: Claims 59274 is expressly identified. Availity and Zelis roles differ; authorizations for pre-2026 dates use the legacy route. Locator: Availity payer ID; authorization transition; legacy portal; claim attachments; Zelis ERA. Version: 2026 transition instructions; no exact publication date established.. Retrieval: content_read; public_web_content_read. This is a partial comparison, not whole-field or whole-record approval.
Primary source for payer_ids.claims, portal_url, provider_phone — avmed: 2026 provider implementation hubpayer_ids.claims, portal_url, provider_phone — AvMed: contact roles
Source comparison: 2026-09-18
Retain claims identifier 59274 and provider phone 800-452-8633 with source scope. Current transition instructions distinguish Availity, legacy authorization requests and Zelis payment functions. Source scope: 800-452-8633 is the Provider Service Center, distinct from Zelis enrollment/support. Locator: Providers / Provider Service Center. Version: No effective/publication date established on checked HTML.. Retrieval: content_read; public_web_content_read. This is a partial comparison, not whole-field or whole-record approval.
Primary source for payer_ids.claims, portal_url, provider_phone — avmed: contact rolestimely_filing_days, payer_ids.eligibility, payer_ids.era, era_payer_id — AvMed: 2026 provider implementation hub
Source comparison: 2026-09-18
The older 2025 reference-guide URL returns 404. The current filing limit remains unresolved. Claims identifier 59274 alone does not verify copied eligibility/ERA fields; no replacement transaction identifiers were established. Source scope: Claims 59274 is expressly identified. Availity and Zelis roles differ; authorizations for pre-2026 dates use the legacy route. Locator: Availity payer ID; authorization transition; legacy portal; claim attachments; Zelis ERA. Version: 2026 transition instructions; no exact publication date established.. Retrieval: content_read; public_web_content_read. This is a partial comparison, not whole-field or whole-record approval.
Primary source for timely_filing_days, payer_ids.eligibility, payer_ids.era, era_payer_id — avmed: 2026 provider implementation hubtimely_filing_days, payer_ids.eligibility, payer_ids.era, era_payer_id — AvMed: EDI resource index
Source comparison: 2026-09-18
The older 2025 reference-guide URL returns 404. The current filing limit remains unresolved. Claims identifier 59274 alone does not verify copied eligibility/ERA fields; no replacement transaction identifiers were established. Source scope: Transaction families are described; linked eligibility guide was not successfully retrieved, so exact eligibility/ERA identifiers remain unresolved. Locator: 5010 Transactions; 270/271 and 276/277 guide links. Version: No effective/publication date established on checked HTML.. Retrieval: content_read; public_web_content_read. This is a partial comparison, not whole-field or whole-record approval.
Primary source for timely_filing_days, payer_ids.eligibility, payer_ids.era, era_payer_id — avmed: edi resource index
Not checked in this pass: Other fields in the immutable 43-field research inventory remain unverified unless expressly scoped in these findings; Whole-record approval, current legal entity/ownership, enrollment and complete insured geography; Every provider agreement, product, claim type, filing/appeal exception and clinical authorization policy; Current transaction-specific enrollment/capabilities and authenticated portal behavior; unknown does not mean unavailable; QuickIntell integrations/outcomes and historical April 2026 DataForSEO demand; Accountable reviewer approval; last_reviewed and reviewed_by remain unchanged.
Sources used for this guide
State coverage
AvMed operates in the following states. Each link opens state-level Medicaid program details, dominant commercial payers, and state-specific RCM regulations.
Evaluate QuickIntell workflow fit for AvMed
These module references are evaluation starting points, not evidence of a validated connection, supported transaction or customer deployment. Confirm the actual member plan, data access and product scope first.
- QuickRCM
Evaluate claim preparation, follow-up and denial worklists for AvMed; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for AvMed; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for AvMed before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about AvMed
Where is the AvMed provider portal?
Use https://www.avmed.org/en/provider/provider-implementation-hub as a starting point for AvMed provider resources. This link may open a directory or contact page rather than a transaction portal. Select the applicable product and administrator, then verify the available functions, enrollment and access requirements. QuickIntell is not the official payer portal.
What is the timely filing limit for AvMed?
The current AvMed transition resources do not establish an initial-claim filing limit. The older 2025 reference-guide URL could not be retrieved; confirm the current product and provider agreement before relying on the registry 180-day seed.
What is the AvMed payer ID?
Claims: 59274 — registry reference; verify the member product, transaction and clearinghouse. Eligibility (270/271): 59274 — registry reference; verify the member product, transaction and clearinghouse. ERA (835): 59274 — registry reference; verify the member product, transaction and clearinghouse. Not verified: Copied ERA identifier 59274 was not independently verified. The current hub directs remittance/payment access to Zelis; confirm the actual product, clearinghouse and enrollment instructions.. Do not substitute a claims ID for an unverified transaction ID. Check current source findings and the member ID card before submitting.
Does AvMed accept electronic claims?
Verify AvMed electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable.
How do I appeal a AvMed denial?
This registry has not established a payer-specific appeal ladder for AvMed. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
How long do AvMed prior authorization approvals take?
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
What is the AvMed provider phone number?
This registry lists 1-800-452-8633 as a contact reference for AvMed. 1-800-452-8633 is the published Provider Service Center; Zelis payment/enrollment contacts are separate.
Automate workflows around AvMed requirements
Connect eligibility, prior authorization, pre-submission claim checks, and remittance routing in one governed workflow. Payer and plan configuration is confirmed during implementation.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. Payer policies change without notice — always verify against AvMed's current published documents before submission. CPT® is a registered trademark of the American Medical Association.