Trading partners and their credentials
Outcome
You know who manages the trading partners your claims travel through, what to ask for when a partner needs to be added or changed, and how to check the result from the RCM app.
Partners are managed by platform operators
The RCM app has no trading-partner screen. Trading partners — the clearinghouses, state Medicaid systems and payers you exchange X12 files with — are registered, configured and credentialed by platform operators in the EDI console, a separate platform application. A partner record, its connection settings, its vault-held credentials and the routing rules that pick it for your claims all live there.
Several partners are shared by every customer on the platform. Availity, for example, is one partner record and one account for all customers; your organization's identity travels inside each claim (the submitter loop, built from your billing entity's name and NPI), not in a partner setting.
Credentials are never entered into, or displayed by, the RCM app. They are held in the platform vault and written by platform operators only.
What to do
To add a partner or change one, open a request with your platform support contact. Give them the partner's name, which transactions you exchange with it (for example
837P,835,270), and any enrollment or account details the partner issued to your organization. Do not send passwords or keys in the request; the operator arranges a secure handover.Keep your billing entity current. For shared partners such as Availity, your billing entity's name and NPI are what identify your claims to the partner. Correct them in the RCM app before submitting.
Check the result by submitting a claim and following it on the claim detail page's Submissions and Timeline tabs.
Validation
| Check | Expected |
|---|---|
| The claim's Submissions tab shows the submission | Yes. |
| The partner's acknowledgments reach the claim | Yes, within the partner's normal turnaround. |
Troubleshooting
| Symptom | Cause | Fix |
|---|---|---|
| Claims are rejected for an unknown submitter | Your billing entity's name or NPI does not match what the partner expects | Correct the billing entity; if it was already right, open a request with platform support. |
| No acknowledgments arrive for a partner | The partner's connection or routing needs an operator | Open a request with platform support, naming the partner and an affected claim. |
The operator procedure is in the EDI manual, Onboard a new trading partner.