Intelligent Gateway and Vendor Integration
Most provider organizations, especially large hospitals and health systems, use electronic health record and practice management systems to interact with health plans. As a result, health plans that want to enhance communication with their provider networks must find better ways to leverage these vendor channels.
Availity’s Intelligent Gateway and Vendor Integration solution drives better integration among health plans, vendors, and providers, which helps to increase data quality and decrease costs for all parties. When working with Availity, vendors are able to access the richest content across multiple health plans through a single integration, while health plans can reach our vast vendor network through a single gateway. This means the providers receive critical health plan information without having to leave the EHR/PM system they use.
Drop-to-Paper, Front-End, and Print Fulfillment Services
Health plans still process a tremendous amount of paper-based claims, which affects processing time and drives up plan administrative costs. With Availity’s print fulfillment services, health plans can offload the manual, time-consuming processes associated with paper. Our centralized mailroom service processes all incoming mail and converts it to a variety of electronic forms. We also offer a BPO service for claims adjudication and call center hosting, reducing the call burden on internal health plan teams.
Availity’s financial solutions address many workflow and data requirements for member and broker to health plan, health plan-to-provider, and patient-to-provider payment and reconciliation. Availity supports the submission of 834 member enrollment and 820 payment advice transactions to health plans from brokers, exchanges, employers, and provides reconciliation capabilities for provider health plan payments by generating and distributing 835 remittance advices. Availity also enables health plans to pay providers via ACH/EFT, check, and virtual cards, and helps providers improve out-of-pocket collections with patient payments and patient statements.
Patient and Claims Management
Availity’s patient management solution helps ensure E&B transactions submitted through the EHR/PM system are transmitted as quickly and completely as possible. Availity is also working to improve the claims management process by streamlining the entire claims lifecycle, from submission, to status updates, to payment and remittance delivery.