Simplify complex processes and improve payer-provider collaboration.
Simplify complex processes and improve payer-provider collaboration.
Streamline workflows and improve engagement.
Maintain compliance by capturing provider updates at the source.
Transform data-sharing capabilities and reduce the cost of care.
Ease prior authorization burdens with AI-driven solutions.
Reduce print and postage costs and replace manual processes.
Lower admin costs and prevent revenue leakage.
Streamline workflows, reduce denials, and ensure accurate payments.
Streamline workflows, reduce denials, and ensure accurate payments.
Seamlessly deliver complete and accurate healthcare information.
Seamlessly deliver complete and accurate healthcare information.
Facilitate seamless data exchange via X12, REST, and FHIR APIs.
Streamline provider workflows and improve collaboration.
Reach more health plans while streamlining pre-service and billing.
Boost efficiency, prevent denials, expedite payments.
Enhance clinical data quality for optimized downstream workflows.
Simplify the prior authorization review process.
Connect to health plans nationwide.
Seamlessly connect and exchange administrative data.
REST and FHIR-based APIs for fast, secure connectivity.
Maintain accurate provider directories.
Streamline data exchange to meet mandatory compliance.
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“Nordstrom knows more about me when I make a purchase than the emergency room knows about me when I show up for care.”
If you work in healthcare, you have probably heard some variations of the above statement. That’s because healthcare lags far behind other industries when it comes to exchanging an individual’s information across organizational boundaries.
The good news is that the industry is making progress with standards like FHIR and FHIR accelerators such as the HL7 Da Vinci project. Da Vinci’s implementation guides provide a “recipe” for using FHIR standards to address specific industry use cases, like prior authorization.
The bad news is that even with a compelling use case like prior authorization, adoption of FHIR has been slow. In talking with people across the industry, I think it comes down to three key issues:
Although payer and provider incentives are not completely aligned, the prior authorization use case offers a true “win-win” opportunity regardless of when or whether CMS finalizes its regulations. But addressing these issues and moving FHIR standards forward requires ongoing collaboration.
Availity is helping drive these conversations. We recently held our annual Availity Connects Healthcare Summit, which brought together industry leaders from 25 payer organizations and 14 provider organizations. These attendees overwhelmingly agreed that prior authorization is the biggest industry pain point. There was strong interest in FHIR as an enabling technology, and we expect many more collaborative conversations over the coming months.