Availity Terms of Use Agreement 2026

1. Click ‘Get Form’ to open the Availity Terms of Use Agreement in the editor.
2. Begin by entering the member information. Fill in the Name, Member ID number, Date of Birth (DOB), and Address fields accurately to ensure proper identification.
3. Next, provide the provider information. Include the Facility name, NPI/TIN, Phone number, Date of admission, Fax number, and Date of discharge.
4. In the care coordination section, input details for the Utilization Manager (UM) including their name, phone number, and fax number.
5. Complete the discharge information by filling out the Discharge address and Discharge phone fields. Indicate if this discharge was against medical advice and whether discharge information was sent to the member’s PCP.
6. For medications, list each medication's name, dosage, frequency, and check if it is on formulary. Ensure preauthorization status is noted as needed.
7. Finally, fill in any required appointment details for follow-up care within seven days and provide your signature along with date and contact information before submitting.

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