The Availity identity verification form is a notarized paper document you complete when Availity Essentials cannot confirm your identity electronically during registration. Fill in your personal information, sign the form in front of a notary public while presenting a government-issued photo ID, and mail the original to Availity’s processing office in Tampa, Florida within 45 days of your application date. Miss that window and the system rejects your registration, forcing you to start over.
Why You’re Being Asked to Submit This Form
Availity Essentials verifies every registrant’s identity. For most people, this happens electronically through a set of knowledge-based questions drawn from public records. If your answers line up, you’re verified instantly. The paper form only appears when that electronic check fails.
Electronic verification fails for ordinary reasons. A recent name change, a new address that hasn’t caught up in public records, a thin credit file, or one wrong answer on the knowledge-based questions can all trigger the fallback. It isn’t a fraud flag. It’s just the next step.
Only the person registering as the organization’s primary administrator goes through this verification. Once approved, that person becomes the Access Account Administrator and can add other users, who go through their own electronic check but won’t need the notarized form unless theirs also fails.
What To Have Ready Before You Print
Gather these before you download the form:
- Your Availity Application or User ID, assigned during registration. Check it against your confirmation email. A single transposed digit means Availity can’t match the form to your pending application.
- Your legal first and last name as they appear on your government-issued photo ID, plus any previously used last names.
- Date of birth in mm/dd/yyyy format.
- A direct phone number.
- Your country and state.
- A current driver’s license, state ID card, or U.S. passport to show the notary.
The form does not ask for your Social Security number, Tax ID, NPI, or professional license number. Those belong to other parts of the organization registration.
Filling Out Your Part
Download the PDF from Availity’s registration portal or help center. The form has three steps printed on it.
Step 1 is your personal information. Every field is required. Enter your legal name exactly as it reads on your photo ID. If you’ve gone by a different last name, add that too. Fill in your date of birth, phone number, country, state, and Application or User ID.
Step 2 is the signature, and this is where people slip up. Do not sign the form at home. Print it with Step 1 complete, then bring the unsigned form and your photo ID to a notary public. You must sign in the notary’s physical presence. A form already signed before you walk in won’t work.
Getting It Notarized
The notary watches you sign, confirms your photo ID matches the name on the form, and completes the notarial certificate. That certificate includes a statement that you personally appeared, presented satisfactory identification, and signed in front of them. The notary fills in the state and county, records the date, signs, and applies an official stamp or seal.
The notary also records a commission number and commission expiration date. If the date, commission number, or seal is missing, the form is likely to come back rejected, and the rejection eats into your 45-day window. Before you leave the notary’s desk, look at every field in the notarial certificate and confirm nothing was skipped.
Notaries are easy to find at banks, UPS Store locations, shipping centers, and law offices. Fees vary by state. New York and New Jersey cap notary fees as low as $2 per signature, while California, Colorado, and Rhode Island allow up to $15 or $25 per act. Call ahead and bring your photo ID. That’s what people forget most often.
Mailing the Original
Step 3 tells you to mail the completed form to Availity. The address printed on the form is:
Attn: Availity ID Verification
10004 N. Dale Mabry Hwy, Suite 106
Tampa, FL 33618
Availity requires the original document with the notary’s wet signature and physical seal. There is no upload tool, email submission, or fax option for this form. A photocopy, scan, or faxed version will be rejected. Use a trackable shipping service so you have proof of delivery if the form goes missing.
The 45-Day Deadline
Your 45 days run from the date you submitted your application in Availity Essentials, not from the date you printed the form or visited the notary. If Availity hasn’t received your completed form by day 45, the system automatically rejects your registration and you’ll have to begin the entire process again.
Plan around mailing time. If you’re in the final week, overnight or priority mail costs less than starting registration over. For status questions, call Availity at 1-800-282-4548.
What Happens After Availity Receives It
Processing usually takes a few business days from the date your form arrives, though timing varies with volume. Availity sends a confirmation to the email on your registration and tells you whether verification is complete or whether more information is needed.
Once verified, you have Access Account Administrator permissions. You can add users, assign roles, maintain provider information, and start using the portal for claims and eligibility work. Users you add will go through their own electronic verification; the paper form only comes back into play if someone’s electronic check fails too.
Common Reasons Forms Get Rejected
An incomplete notary section is the most common problem. A missing commission number, an illegible seal, or a blank date each cause a rejection on their own.
Name mismatches are the next most common. If your ID says “Katherine” and you wrote “Kathy,” the notarial certificate won’t line up with what Availity expects. Use your full legal name as printed on the ID, and make sure the notary records the same name.
Submitting a photocopy instead of the signed and sealed original is also a frequent miss. The form has to arrive as the physical document the notary stamped. If your form comes back for any reason, you’ll get an email explaining what went wrong, but every resubmission runs against the same 45-day clock. Getting it right the first time is the fastest path through.