Welcome to Availity’s EDI 101 series. Where we answer your most frequently asked questions about healthcare connectivity.

Does it ever feel like the language around healthcare transactions is purposely confusing? Do you find yourself googling terms…and still not...

Availity’s strength lies in the diversity of our people, with each associate bringing something unique to the organization. By celebrating our...

We are proud to announce that Availity has been certified as a Great Place to Work! Great Place to Work® - the global authority on workplace culture -...

Coverage identification tools help providers find active member coverage by sending multiple eligibility inquiries (270) to payer networks until they...

COVID-19 has left many communities shattered; businesses on the brink of closure, some already completely shut down, and unemployment rates reaching...

What have we learned from the early response to the pandemic, and what changes could we see in healthcare as a result? Find out in the new Availity...

October is National Cyber Security Awareness Month and as healthcare professionals, we play an important role in protecting the safety and security of...

It’s always nice to find little shortcuts that saves you time. Like taking a little-known side street that bypasses a heavy traffic area. Or picking...

In January of 2018, the American Medical Association, along with stakeholders from many other payer and provider organizations, released a consensus...

Telemedicine is finally having its moment. It’s long been viewed as a potential way to reduce healthcare costs and drive better coverage among...

COVID-19 has forced most healthcare organizations to restructure the ways they operate. Practices and hospitals not on the frontlines of fighting the...

Because many of us are using the lull in our normal routines to brush up on skills or learn new ones, we thought this would be a good time to remind...

The economic downturn caused by the COVID-19 crisis has forced many companies to pause hiring or implement temporary furloughs. At Availity, we are...

Even in the most technology-savvy provider offices, there may be lingering paper-based manual processes eating away at your bottom line. Perhaps you...

As you practice your social distancing in the coming weeks, check out some of these valuable online presentations...

Nineteen million. That’s the number of pages of documentation one health system receives each year from health plans, according to a revenue cycle...

If you are an Epic shop and considering a new Revenue Cycle Management (RCM) system, there are many questions to consider before moving forward.

As Product Line Manager, it’s my job to try different approaches for gathering better feedback from our users. That’s why, when I was first tasked...

Availity helps healthcare providers and health plans connect, making it easier to share clinical, financial, and administrative information. We value...

We may never completely eliminate denials, but there are ways to proactively prevent them, particularly recurring denials caused by your claim...

Countless businesses and healthcare organizations miss out on their portion of available settlement proceeds each year. On average, only about 20% of...

In a recent webinar, we discussed the importance of patient satisfaction and how it can impact the revenue of your practice. Understanding patient...

In a recent webinar TSYS coordinated with Availity, we discussed the importance of understanding today’s patients and their unique expectations. This...

A key to patient engagement is keeping your clients as informed as possible about their options for treatment, medications, recovery, and all other...

There’s a fun phrase about dental practices: “When the front office hums, the back-office dances.” How does the front office hum? Let me paint you the...

“Inform before you perform.” Does your office have a written financial policy? If not, you should. This policy should be presented to and signed by...

The General Data Protection Regulation (GDPR) governs the privacy and security of personal data collected from the European market, effective May,...

Consumers with health insurance, both independent and employer sponsored, rely on insurers’ provider directories to make choices about their plans and...

The healthcare industry still has a big paper problem. According to one report, faxes account for almost 75 percent of all medical communication.

Health plans are committed to reducing waste and inefficiency, but the healthcare industry as a whole still spends too much time and money manually...

Claim submissions are the most common electronic transactions in healthcare, edging out even eligibility and benefits checks, which are often still...

Countless businesses and healthcare organizations miss out on their portion of available settlement proceeds each year. On average, only about 20% of...

CMS’s recent report on the state of provider directories identified three challenges facing health plans. Recent blogs covered the first two...

The second problem CMS identified in its report on provider directories was a lack of internal audits by health plans to verify provider information....

The RISE conference in Nashville was a great opportunity to learn about new approaches to analytics and member engagement, as well as to hear about...

What’s the current state of payer-provider collaboration, and what does the future hold? Big questions to be sure, but we tried to find answers during...

CMS has identified three drivers of directory deficiencies: group vs. provider-level data, lack of internal audits, and reliance on provider-led...

In its second annual report on the state of provider directories, the Centers for Medicare and Medicaid Services (CMS) found that 46 percent of all...

Recently, three trends have aligned to signal highly favorable conditions in the independent radiology space for the coming year. These trends are:...

Availity understands that if you want to drive provider engagement, you need to find new ways to automate healthcare transactions. That’s why we are...

Join us Friday, 11/10 at 1pm ET for our tweetchat, Confidence Through Compliance, featuring our favorite HIPAA lawyer, Matt Fisher (@Matt_R_Fisher),...

In this edition of Availity Access, Mark Martin, product line director for provider data, discusses why addressing credentialing is the next logical...

Working in healthcare guarantees you’ll be interrupted multiple times a day, whether it’s by staff, patients, physicians, or health plans....

Availity recently commissioned an independent research company to survey providers—physicians and non-medical staff, in practices and facilities—about...

“If you see this text, then your files are no longer accessible because they have been encrypted.” This is the on-screen message many organizations...

Join us Friday, 10/13 at 1pm ET for our tweetchat, Healthcare Credentialing: The Good, the Bad, and the Scary, featuring Michelle Barry, our expert of...

The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) was passed to make healthcare delivery more efficient and to protect the...

Recognizing the need for greater automation, the CAQH Committee on Operating Rules for Information Exchange® (CAQH CORE®) brought entities from across...

Supporting our communities has always been a part of Availity’s corporate culture. By providing a variety of opportunities to give—and by making it...

In our latest vlog series, Mohammed Ahmed, Availity’s Vice President of Authorizations Sales Enablement, provides insight into the key features and...

Join us Friday, 9/8 at 1pm ET for our tweetchat, Big Data - Present, Future, and Best Practices, featuring Availity Director of Data Management and...

In our latest vlog series, Mohammed Ahmed, Availity’s Vice President of Authorizations Sales Enablement, provides insight into the key features and...

In our latest vlog series, Mohammed Ahmed, Availity’s Vice President of Authorizations Sales Enablement, provides insight into the key features and...

Join us Friday, 8/11 at 1pm ET for our tweetchat, Patient as the New Payer – Patient Payments, featuring TSYS’s Director of Relationship Management,...

In our latest vlog series, Mohammed Ahmed, Availity’s Vice President of Authorizations Sales Enablement, provides insight into the key features and...

On this journey to value-based care, providers and health plans agree that collaboration is critical to their success. But significant investments in...

Two things health plans and providers can agree on are the importance of improving patient satisfaction and lowering administrative costs. They also...

Join us Friday, 7/14 at 1pm ET for our tweetchat, The (Continued) Case for Interoperability, featuring our own Platform Solutions Architect, David...

Understanding the needs of customers is paramount to any business’s success. And for Availity, a long-time, trusted intermediary between health plans...

Elizabeth Woodcock, a leading expert on medical practice operations, is on a mission to help the healthcare industry improve the patient experience....

If you’re a healthcare provider still processing most claims manually, you know first-hand the challenges this presents. First, you deal with a lot of...

Is your revenue at risk? If your hospital or practice isn’t fully adhering to the risk adjustment and Hierarchical Condition Category (HCC) coding...

A recent report by CAQH demonstrated that outdated, time-consuming manual processes are still being utilized to exchange information between insurers...

Join us Friday, 4/14 at 1pm ET for our Assessing Quality Measures tweetchat featuring our own Risk Queen, Susan Bellile (@SKB_RnQ), and The Healthcare...

“How well does this vendor integrate with Epic?” It’s an increasingly important question among hospitals and health systems that run Epic and are...

Any successful company recognizes the importance of customer touchpoints—those critical moments when a customer engages with someone in the...

Last year, Availity, the nation’s largest real-time health information network, participated in a pilot initiative with America's Health Insurance...

Join us Friday, 3/10 at 1pm ET for our Ransomware Predictions and Prevention tweetchat featuring Matt Fisher (@Matt_R_Fisher) and Erik Azar (@eazar),...

Because patients are paying more out of pocket for their healthcare, you might be focusing on improving patient collection processes. While that’s...

Learn what 3,000 undeliverable postcards says about provider directories and why keeping this basic information up-to-date is so challenging.

With all the uncertainty, there’s one question that keeps surfacing—will risk adjustment go away if Congress repeals the Affordable Care Act (ACA)?...

As part of a partnership with the Illinois Critical Access Hospital (ICAHN), Availity is working with several hospitals across the state to streamline...

In this episode of Availity Access, Jeff Chester, Availity’s Chief Revenue Officer and Senior Vice President, discusses what he sees as the big...

Nationwide, just over six percent of healthcare claims are submitted using paper forms. That number has remained steady over the past few years, even...

If you are an Epic shop and considering a new Revenue Cycle Management (RCM) system, there are many questions to consider before moving forward.

Whether you’re new to healthcare or a seasoned veteran, understanding the revenue cycle is tough—not to mention staying up-to-date with myriad...

As 2016 comes to a close, you are probably wrapping up a few last projects and making your holiday vacation plans. Before you scoot off to grandma’s...

We know what you want for the holidays – Risk Adjustment! That’s why we’re hosting our third #AskAvaility tweetchat on Friday, 12/9 at 1pm ET,...

A business continuity plan is a dynamic tool used during emergencies, catastrophic events and natural disasters where buildings, personnel, and...

We’re back at it again with another #AskAvaility tweetchat! Join us on Friday, 11/11 at 1pm EST for Exploring APIs in Healthcare. Steve Sisko...

With more patients enrolled in high-deductible health plans, front-desk employees are facing difficult questions from patients about their healthcare...

A recent Availity survey of providers found that almost half still mail or fax their risk assessments to payers. Results suggest this is because each...

In a data-driven world, metrics matter. But it’s just as important to make sure you are tracking the right metrics—those that give you a complete...

October 1, 2016 marked the one-year anniversary of the ICD-10 implementation, and the milestone coincided with significant changes to ICD-10 codes...

Confronting the threat of ransomware in healthcare: 3 steps to help safeguard your entity and business associates against attacks.

Come join @ShimCode and @HIT_MMartin to talk about the communications (or lack thereof) between providers and payers and the ways in which we can...

In this episode of Availity Access we discuss the problems caused when payers and providers each build their own solutions to manage patient data.

Cyber threats represent a big risk to healthcare practices but keeping your staff up-to-date on HIPAA training will send the message that this topic...

In this episode of Availity Access we discuss solutions that can streamline data sharing processes and reduce manual workflows for payers and...

In this episode of Availity Access we discuss how automation has affected the claims submission and processing activities for payers and providers.

The landscape of social media is fast-changing and the law is sometimes one step behind. Here are 4 ways your hospital or medical practice can take to...

In this episode of Availity Access we discuss how health plans can optimize their risk adjustment processes by going digital in their providers’...

In this episode of Availity Access we discuss big data and the challenges it presents for risk adjustment.

Availity Access provides a glimpse into the people behind our products. It features commentary on challenges facing the healthcare industry and how...

Risk adjustment is used to calculate the underlying health status of a health plan’s population. For Medicare Advantage, it is the most significant...

The Care Cost Estimator is another example of how healthcare organizations are using APIs to facilitate communication between health plans and...

MACRA offers multiple pathways with varying levels of risk and reward for providers to tie more of their Medicare payments to value. It’s important...

It seems like every day there’s a different news story about millennials. What they buy. How they communicate. How to work with them. Not since their...

Availity Access gives viewers a glimpse into the people behind our products. It features commentary on challenges facing the healthcare industry and...

Health plans are increasingly under pressure to maintain accurate provider directories, or they risk regulatory fines and potential third-party...

Following the horrific June 12, 2016, shooting at the Pulse night club in Orlando, Florida, news outlets across the country rushed to report on the...

It is not an overstatement to say the healthcare industry has experienced unprecedented change since the Affordable Care Act (ACA) was passed in 2010....

“Sudden” changes in the information we have and how we use it are usually not all that sudden, and it’s almost impossible to predict their effects....

The American Recovery and Reinvestment Act of 2009 created an electronic health record (“EHR”) incentive program, commonly referred to as “Meaningful...

As long as there’s been medical insurance claims there’s been a tug-of-war between payers and providers. Payers want clean claims and providers want...

Providers submit millions of claims to payers every day. Most are adjudicated promptly and for the full contracted amount, but a fraction of these...

In two recent blog posts, we talked about the promise “Big Data” holds for risk adjustment and some of the challenges health plans face with existing...

Payers need information about the population of members in their health plans to predict and track healthcare costs, and to comply with regulatory...

The administrative employees of critical access hospitals typically wear many hats. With extremely tight margins and few alternative funding sources,...

Healthcare providers are in the middle of enormous change. Declining reimbursement, the transition from fee-for-service to value-based payment models,...

In a recent blog post, Can “Big Data” help address the challenges of risk adjustment,” we looked at why risk adjustment is critical to the successful...

When open enrollment begins for Qualified Health Plans (QHP) offered through a Marketplace in 2017, eligible individuals and families will—for the...

Much has been written about “Big Data” and its potential for helping companies turn information it collects into critical business insights. Amazon’s...

As the healthcare industry transitions to value-based models of care and reimbursement, providers and payers need to engage with one another to align...

Healthcare providers know all too well how consumerism is affecting their bottom line. As high-deductible plans become more common and patients are...

Based on feedback from recent healthcare events, including last fall’s Health 2.0 and this month’s J.P. Morgan Healthcare Conference, many expect 2016...

In a previous blog, “Learn How a Settlement Recovery Service Can Help You and Your Organization”, we introduced several types of settlements. One of...

The Affordable Care Act (ACA) requires health insurance companies to spend a minimum amount of premiums collected from members on specific categories...

Few healthcare technology implementations are as expensive, complex, and involve as many stakeholders as an electronic health record (EHR). Many...