AI TOOL PROFILE
Availity: Healthcare Information Network
- Healthcare
- Healthcare Interoperability
- Medical Practices
- Health Insurance Payers
- Healthcare IT Vendors
- Revenue Cycle Managers
Pricing
Pricing was not clearly available from the provided evidence. Buyers should confirm current pricing on the vendor website.
At a glance
- Best for
- Medical Practices, Health Insurance Payers, Healthcare IT Vendors, Revenue Cycle Managers
- Key use cases
- Automating Prior Authorizations, Supporting Claim Accuracy, Interoperability Compliance, Standardizing Clinical Data
- Official website
- Visit availity official website
How AI is used
Availity serves as a digital network between healthcare providers, insurance payers, and health information technology (HIT) companies. The platform facilitates the exchange of clinical, administrative, and financial transactions to support healthcare billing and approvals.
For providers, the tool is designed to support revenue cycle management by facilitating eligibility checks and helping to reduce claim denials. Payers can use the network to coordinate provider engagement and manage clinical data acquisition through standardized formats.
HIT vendors can use the platform's API marketplace to connect their software with a network of payers and providers. The system also supports regulatory requirements, such as CMS-0057-F compliance, using FHIR APIs.
Buyers should confirm specific connectivity options for their practice or plan and verify if their existing EHR or billing system is compatible with Availity's integration methods.
Key Features
Prior Authorization Automation
Uses AI-driven workflows to help manage and automate the prior authorization process between providers and payers.
Revenue Cycle Management
Supports pre-service and post-adjudication workflows to help reduce claim denials.
CMS-0057-F FHIR APIs
A suite of APIs designed to help meet interoperability mandates and support standardized data sharing.
Multi-Payer Portal
A centralized portal that allows providers to interact with multiple health plans through a single interface.
Payment Accuracy Solutions
Uses AI to help identify and shift claim edits earlier in the lifecycle to reduce administrative waste.
Clinical Data Solutions
Supports the acquisition and normalization of clinical data, converting formats such as HL7v2 and Flat Files into FHIR resources.
Digital Correspondence
Digitizes paper-based provider communications for digital delivery.
Use Cases
Automating Prior Authorizations
Supporting the process of determining if a service requires authorization and submitting requests through EHR workflows.
Supporting Claim Accuracy
Using real time eligibility checks and claims editing to help reduce the rate of denied claims.
Interoperability Compliance
Using FHIR-based APIs to support CMS mandates for patient access to electronic medical records.
Standardizing Clinical Data
Converting legacy data formats into analytics-ready FHIR resources for better data management.
FAQ
What does Availity do for healthcare providers?
- It helps providers manage their revenue cycle by offering secure connections to payers for eligibility checks and prior authorization automation.
How does Availity support healthcare interoperability?
- Availity provides a CMS-0057-F compliant FHIR API suite that helps organizations standardize and exchange clinical data.
Who is the Availity platform designed for?
- The platform is designed for healthcare providers, health insurance payers, and health information technology (HIT) companies.
Can Availity help with claim denials?
- Yes, it offers revenue cycle management tools and claims editing designed to help reduce denials by supporting workflow automation.
Source category: Healthcare
Source subcategory: Healthcare Interoperability
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