bannerImage.Alt
Regulatory Compliance
 

Compliance at Availity

 

Mission, Vision, and Values

Mission: Availity's Compliance, Privacy, and Ethics program mission is to promote a culture of ethics and compliance with laws, regulations, and company policies. We strive to support our colleagues, leadership, business partners, and customers by providing proactive, collaborative, and consultative guidance to finding the ‘yes,' while maintaining the fundamental expectation of doing the right thing. Our commitment to upholding the highest ethical standards and privacy protections sets us apart from our competitors.

Vision: Availity's Compliance, Privacy, and Ethics program is a proactive partner that will protect, support, and educate the company and customers it serves by setting industry-leading standards for ethical and appropriate business conduct.

Values:

Code of Conduct and Ethics

Availity has a long-standing and deep commitment to conducting business ethically, with integrity and in compliance with the law. Availity employees, and how they conduct themselves each and every day, are the key to Availity’s business success. This is why we make it a priority to educate our management, employees, and contractors on our high ethical standards through training, communications Availity Code of Conductand the promotion of dialogue in ethical dilemmas. 

Supplier Code of Conduct

The ethical business practices of Suppliers is essential to providing the best possible service to our customers. Our Supplier Code of Conduct sets forth Availity’s expectations of Suppliers as well as their personnel, agents, and subcontractors. All Availity Suppliers are required to hold themselves to the same high ethical standards that Availity promotes.

Our Compliance Program

Availity’s Compliance Program is structured in accordance with the Seven (7) Elements of an Effective Compliance Program as proscribed by the Federal Sentencing Guidelines issued by the United States Sentencing Commission and the Health and Human Services (HHS) division of the Office of the Inspector General (OIG). The following Programs are maintained as part of Availity’s Compliance Program: HIPAA Privacy Program, Anti-Bribery and Anti-Corruption (ABAC/FCPA) Compliance Program, and the General Data Protection Program.

The seven (7) elements of an effective compliance program are:

Availity Compliance Seven Core Elements

Knowing the Risks

Healthcare statutes, rules, regulations and obligations can be extremely complex and ambiguous at times and penalties for non-compliance can be quite severe. At Availity, we recognize the importance of taking preventative measures to minimize the risk of a violation. Availity is continually assessing risk within the organization by conducting various privacy and security assessments both annually and on a rolling basis. We have pushed risk assessment deep into the organization and these assessments help to identify risk concerns throughout the year. In addition, Availity follows requirements and standards established by CMS, EHNAC, and HITRUST for risks associated with our industry, which include, but are not limited to HIPAA Privacy and Security.

Transparency in Coverage

The Transparency in Coverage Final Rules require certain group health plans to disclose information regarding in-network provider rates and historical out-of-network allowed amounts and billed charges for covered items and services in two separate machine-readable files (MRFs). The MRFs for the benefit package options under Availity, L.L.C. Health and Welfare Plan are linked Here.

Helpful Links and Materials

A Summary of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Protected Health Information (PHI) is individually identifiable health information that is held or transmitted by a covered entity or business associate in any form or media (electronic, paper or oral). Below are the 18 identifiers of PHI:

Compliance PHI Identifiers

Speaking Up

At Availity, we believe that knowing when and how to report ethical issues is just as important as being educated on our ethical standards. The Compliance Program is designed to facilitate open dialogue with anyone who wishes to report an issue or concern. The Compliance Team maintains open lines of communication and encourages anyone with any ethical or compliance concern regarding Availity to reach out as soon as the concern arises.

To report any compliance or ethical concerns about Availity, its employees or its vendor partners please use the following methods:

 
play video