How Availity Works With Health Plans
Helping remove cost and challenges for health plans
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 health information network provides a solution by making data from multiple health plans like yours available in one standardized and simplified interface for providers.
It's easier and faster for providers to access multiple health plans on Availity's online network than to visit several websites or make lots of phone calls. Plus, they get access to innovative tools, like Availity® CareCost EstimatorSM, our patient financial responsibility calculator or CareProfile®, a longitudinal care 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 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.
The following products and services are supported on the Availity Health Information Network and may be integrated with practice management systems, electronic medical record systems, billing software, and hospital information systems.
- Availity® CareCollectSM: Automated payment collection
- Availity® CareCost EstimatorSM: Patient financial responsibility estimation
- Availity® CareProfile®: A longitudinal care record
- Availity® CareRead®: Member ID card swipe
- Claim Attachments: Electronic submission of supporting claim documentation
- Claim Reconciliation: Reconciliation of multiple claims
- Claim Status Inquiry: Verification on the status of a claim
- Claim Submission: Submission of individual or batch claims
- Eligibility and Benefits Inquiry: Confirm coverage and out-of-pocket expenses
- Authorizations and Referrals: Submission and verification of authorizations and referrals
- Remit ReaderSM: An electronic remittance advice reader
Return on investment
Health plans fund the transactions processed through the Availity Health Information Network. The subsidies plans contribute underwrite the cost for care providers to access to all of the most common electronic transactions, enabling widespread adoption and lower barriers to entry for the providers.
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. Examples include:
- Net savings of $3.2 million at one health plan, as measured by a reduction in provider calls over a two-year period
- 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 $1-plus per member, per year in combined FTE, direct, and allocated IT expenses
- Electronic claim submission increased from 71.34% to 79.88% in one year, for one health plan
- 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, saving $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 services that help patients understand coverage and manage out-of-pocket expenses
- Stronger business positioning by leveraging Availity's ability to create and market services that benefit provider business operations and clinical decision-making
- Time and cost savings, when management/integration of vendor or technology companies are shifted to Availity