Availity Blog

APIs help healthcare address pricing transparency


8.18.2016 by HEATHER DONOVAN, API Product Owner


As consumers seek more transparency in their healthcare costs, state and local jurisdictions are passing legislation to make it easier for them to do so. Florida Governor Rick Scott recently signed a law mandating that hospitals and surgery centers publish price ranges for common procedures and offer a way for plan members to estimate their out-of-pocket expenses. The law also allows consumers to request good-faith estimates from healthcare providers, who must respond within seven days.

For providers and health plans, this law—and others like it—means they must find ways to deliver consumer pricing transparency more quickly, without increasing administrative costs. Today, many providers call the health plan directly to get estimates, which is time-consuming for both sides. One health plan analyzed a single month’s call volume and found that calls for predetermination requests added nearly $10,000 to its administrative costs.

In an effort to address these costs, Availity is working with that health plan to implement an application programming interface (API) specifically for estimating care costs. This API will allow providers or third parties to submit predetermination requests online and receive an accurate estimate of both the anticipated claim reimbursement and the patient’s out-of-pocket costs. Because the results will be much faster than a phone call, the plan expects rapid adoption by providers.

The Care Cost Estimator is another example of how healthcare organizations are using APIs to facilitate communication between health plans and providers—without having to develop custom solutions. Not only do APIs reduce development time and costs, but they helps plans deliver more accurate estimates to providers and their patients.

For a technical perspective on APIs, including the new Care Cost Estimator API, visit our developers blog unmarshalarts.com and our developers website developer.availity.com.

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