Optimize your revenue cycle and get paid quickly

Today’s healthcare environment is a challenging one for providers with staffing shortages, reduced reimbursement, and rising cost of care. Providers also contend with inefficient revenue cycle systems and payment processes that make it difficult to collect what they are owed.    

Availity helps providers prioritize patient care with automated solutions that address the three key phases of the revenue cycle: pre-service, post-service, and post-adjudication.

Pre-service

Prevent downstream revenue cycle errors

Capturing accurate and complete patient coverage information at or before the patient visit reduces the chance of claim denials or delays in care, while also helping providers collect the right amount from patient. Availity helps providers:

• Get complete, up-to-date eligibility and benefits information integrated directly into the provider EHR  
• Find active coverage even when the patient doesn’t think they have it  
• Know when a prior authorization is required without having to call
• Submit prior authorizations and receive status updates in the EHR
• Know the extent that a patient can pay and offer tailored, targeted payment options

Post-service

Submit cleaner claims and monitor claim status

The best time to fix claim errors is before the claim is submitted to the payer. Availity’s post-service revenue cycle solutions can be the difference between a claim that’s quickly paid and one that sits in pended status. Availity’s post-service solutions let providers:  

• Submit professional, institutional, and dental claims via batch and direct data entry
• Submit and manage Workers Compensation claims
• Electronically attach and submit medical records with claims   
• Receive robust claim status information from the health plan
• Leverage AI to monitor claims most likely to deny and edit them before submission

Post-adjudication

Research and resolve claims more quickly

Revenue cycle staffing shortages make it difficult to dedicate enough back-office staff to work through all denials. Availity’s post-adjudication workflows automate many critical tasks allowing staff to more easily:

• Receive remittances matched back to the correct claim
• Assign, organize, and work denials by leveraging real-time analytics and pattern reporting
• Create ERAs from paper payments and automatically post to practice management system