Ayin Health Solutions is very interested in receiving electronic claims from your agency. Please read through the following information regarding claim submission requirements and do not hesitate to contact us so that we can make this work!
Ayin is the third-party administrator for various health. A full list of the plans we administer can be found under the EDI Submitter Checklists forum at the link below.
EDI Submitter Checklists
Ayin accepts claims DIRECT from providers OR from CLEARINGHOUSES in the ANSI X12 5010A1 837 Professional, ANSI X12 5010A2 837 Institutional and ANSI X12 5010A2 837 Dental claim formats. Submitter Checklists for each of the plans can be found at the link above. This information may be helpful to your technical staff or business system vendor. The document contains a short list of fields with the values that we require in those fields in order to submit electronic claims to Ayin. The rest of the standard required fields should be populated as usual, including for example claim rendering provider ID information. In addition, you must be able to separate the claims into files by carrier and send separately.
Please remember that Oregon Medicaid and Medicare Advantage members are all "Subscribers" so there should be NO dependents listed in your claim files.
The claim files will need to be submitted via SFTP (Secure File Transfer Protocol) and an account on our web portal will be created for your organization and accounts for each staff needing to transmit claim files. Instructions regarding uploading files using SFTP are provided once your requested accounts have been created.
Please click the link below to get started with claim submissions. The link will take you to a form to fill out.