How Availity Works With Health Plans
Skyrocketing costs. Patient privacy. Increasing competition. Strained provider relationships.
At Availity we understand your challenges. In fact, we were founded by professionals from competing health plans who wanted to do things differently. Our secure network provides solutions by making data from multiple health plans, like yours, available in one place for providers.
It’s easier and faster for providers to access multiple health plans on Availity’s online network than to visit several web sites or make lots of phone calls. Plus, they get free access to innovative tools—like our CareCost EstimatorSM patient financial responsibility calculator or our CareProfile® electronic health record. That’s how we attract more providers to our network, and more providers equals more electronic transactions for you and less operational overhead.
Health plans benefit from reduced operational costs
With thousands of providers in our network accessing the free products and services listed below, health plans benefit in several ways: improved electronic throughput, increased provider self-service, stronger provider relationships, reduced costs, and freed-up capital. These products and services are supported in a secure online network and may be integrated with practice management systems, electronic medical record systems, and hospital information systems.
- CareRead®: Member ID card swipe to automate data entry and eliminate data entry errors
- Eligibility and Benefits Inquiry: Confirmation of coverage and out-of-pocket expenses
- Health Care Services Review and Inquiry: Submission and status verification of authorizations and referrals
- Claim Submission: Submission of clean claims one at a time or in batch; real-time adjudication (RTA) responses are supported for health plans that support RTA
- Claim Attachments: Electronic submission of supporting claim documentation requested by health plans
- Claim Status Inquiry: Verification on the status of a claim
- Claim Reconciliation: Reconciliation of multiple claims
- Electronic Remittance Advice: Electronic payment explanation
- CareCost EstimatorSM: Patient financial responsibility estimation
- CareCollectSM: Automated payment collection
- CareProfile®: Consolidated electronic health record across health plans and providers
- CarePrescribeSM: Electronic submission of new prescriptions and renewals
Return on investment
Health plans fund the transactions processed through the Availity Health Information Network.
And as a result of their participation, health plans have realized significant reductions in customer service calls, paper claims, processing errors, and more, saving millions annually. Here are just a few examples from a range of health plans:
- Net savings of $3.2 million as measured by a reduction in provider calls over two years
- Closing of a call center following dramatic drop-off in call volume
- Reduced EDI claim acquisition cost by 25%
- A 33% reduction in vendor-management costs
- Savings of $1PMPY in FTE, direct, and allocated IT expenses
- Electronic claim submission increased from 71.34% to 79.88%
- Reduced EDI support from 12 FTEs to four
- Redeployment of a five-person vendor management team
- Consolidation of more than 100 hospital frame relay connections
- Virtual elimination of a modem bank saved $40,000 monthly in connectivity costs
Other benefits Availity brings to health plans
- Stronger provider relationships stemming from improved financials and streamlined claim workflow
- Increased satisfaction from products and services that help patients understand coverage and manage out-of-pocket expenses
- Stronger business positioning by leveraging Availity’s ability to quickly create and market products and services that help providers
- Time and cost savings when management and integration of vendor or technology companies are shifted to Availity