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AI-powered authorization reviews for health plans

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Unlike many healthcare transactions, prior authorization is not a simple inquiry and response. It’s a complex conversation that evaluates medical necessity against a member’s medical record and a health plan’s guidelines. Availity AuthAI™ simplifies this process by tackling the problem at a critical touchpoint—determination of medical necessity.

Submission

Streamline authorization submissions and adhere to CMS compliance mandate

Availity helps payers reduce provider abrasion by making it easier for providers to submit authorizations, enabling compliance with Centers for Medicare & Medicaid Services’ (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F).

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Determination

Automate up to 80% of the utilization management workload

With insight captured from clinical data and a payer’s unique medical policies, AuthAI eliminates the manual review process, and—in most cases—can recommend approval in seconds. As a result, payers can: 

  • Reduce administrative burden and manual processes
  • Increase operational cost savings, with some estimates up to 50%
  • Enhance provider and member satisfaction
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Learn more about how Availity can help

Product

Availity Essentials

Learn how Availity can help your health plan streamline provider workflows and improve collaboration.

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Product

Availity Essentials Pro

Boost efficiency, prevent denials, expedite payments with Availity Essentials Pro End-to-End RCM.

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Product

EDI Clearinghouse

Discover how Availity can help you connect to health plans nationwide with its EDI Clearinghouse.

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Product

Intelligent Gateway

Learn how Availity can help you seamlessly connect and exchange administrative data with providers and other trading partners.

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Solution

End-to-End Authorizations

Learn how Availity eases prior authorization burdens with AI-driven solutions to help reduce costs and improve care.

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Whitepaper

AI in Authorizations Whitepaper

How AI, automation and business intelligence are changing the prior authorization game.

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Case Study

How one health plan realized more than $1 million in administrative savings with upfront claims editing

A regional health plan needed a solution that would reduce the costs associated with claims rework without increasing provider abrasion.

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Case Study

HCSC & Availity Partner to Accelerate Fast Healthcare Interoperability Resources (FHIR®) Compliance

Learn how Availity helped HCSC deploy a technology solution to ingest, standardize, and manage myriad clinical data streams and effectively convert legacy data formats to FHIR.

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