Why Availity

Availity’s Intelligent Utilization Management (UM) solution can drive needed change at scale. Availity is uniquely positioned because of our foundational infrastructure: a nationwide network that connects health plans, providers and health IT vendors; an innovative platform featuring a proprietary AI clinical engine; and a robust partner ecosystem.

The Intelligent UM’s Prior Authorization module features three key workflows designed to streamline the end-to-end process: Auth Pathway, Auth Pathway Exchange, and Auth Pathway Compass.

Auth Pathway  

Simplify Prior Authorization Submission

When it comes to prior authorizations, health plans and providers really do want the same thing—a better submission process. Health plans want to eliminate manual submissions, ensure submissions are routed quickly and correctly, and receive complete and up-to-date clinical documentation as part of the submission.  

Providers want speed, simplicity, and transparency—ideally within their existing workflow to submit requests and receive rapid responses.   

Availity’s Auth Pathway solves this two-sided challenge by establishing the foundation for how health plans receive authorization requests from providers. It creates a bi-directional capability to the utilization management decisioning team–whether managed in-house by the health plan or externally via a delegated vendor.

Auth Pathway Compass  

Accelerate Utilization Management Decisioning

One of the best ways to streamline the prior authorization processes is to ensure utilization management clinicians are working at the top of their licensure and focusing on complex cases that require their expertise. To do this, they need a better way to identify the cases where medical necessity can be determined in near real-time with appropriate clinical documentation.     

Auth Pathway Compass helps utilization management teams build much-needed, intelligent capacity by leveraging Availity’s proprietary clinical engine, which analyzes case-specific clinical data against codified medical policy to make a transparent and traceable recommendation.  

For cases that pend, Auth Pathway Compass delivers speed and precision to the review process by surfacing relevant information in an easy-to-view format, allowing clinicians to review pended cases in a fraction of the time without sacrificing quality.