Availity Blog

Want to Drive Provider Engagement? Offer More Automated Transactions.


11.07.2017 By Clay Robertson, Business Solutions Expert, Availity


Availity’s Provider Engagement Portal now features automated appeals and overpayments

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 introducing two new automated workflows within our Provider Engagement Portal: appeals and overpayments.

Today, appeals and overpayments are largely handled through a manual process—even when the original claim was processed electronically. An appeal, also known as a dispute, reconsideration, or grievance, is initiated by providers when they disagree with a claim denial or reimbursement. An overpayment is initiated by a health plan to recover reimbursement from a claim that has been paid to the provider.

While they are two different processes, they both involve extensive back and forth communication between the health plan and the provider. They also require supporting documentation to be printed and either mailed or faxed. For both health plans and providers, this means dedicating time and resources to resolving these issues, which increases administrative costs and slows down resolution.

Here’s how Availity improves the process for both the appeals and overpayment processes:

Leverages a multi-payer platform

As a multi-payer platform, the Availity Provider Engagement Portal gives providers a single, secure location to log on, review the claim status across multiple health plans, and initiate appeals using a common workflow. With the overpayment process, plans can use the portal to submit requests to providers so that they are readily available and easy to execute.

The true benefit of the multi-payer portal for appeals and overpayments is that regardless of health plan, the processes, screen presentations, and navigation are consistent. However, the portal also includes payer-specific business rules, which guide providers through the exact steps they need to complete and correctly submit an appeal or respond to an overpayment request.

Supports communication within the workflow

Whether providers are appealing a denial or they are responding to an overpayment request from a plan, there are many back and forth communications between the two parties. In a manual environment, this can be expensive and complicated. It’s easy to lose track of the next step in the process or to misplace the documentation altogether. With notifications available in the Portal, providers know as soon as they need to take an action.

Reduces paper

Even if a claim is submitted electronically, the appeal and overpayment processes currently require that supporting documentation be printed and either faxed or mailed. Within the Provider Engagement Portal, providers can submit documentation electronically directly into the claim, reducing the chance that documentation is misplaced and once again reducing time and expense.

About the Availity Provider Engagement Portal

The appeal and overpayment workflows are just two of the many automated processes providers can take advantage of within Availity’s Provider Engagement Portal. Learn more about how the Portal can reduce costs and inefficiencies for both plans and providers, ultimately improving the quality of care.


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