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Reduced Costs, Increased Engagement

Availity helps health plan realize 300 percent first-year ROI

Challenge

Each year, a large payer organization registers nearly 10,000 healthcare providers and adds more than 3,000 to its networks. Faced with a looming federal mandate to improve the quality of its provider directories, the health plan wanted a better way to manage its provider data without hiring additional staff. Rather than relying on a patchwork of costly manual processes—phone calls, faxes, and letters—to support provider directory maintenance, the health plan partnered with Availity to implement its Provider Data Management (PDM) solution.

  • Provider registration reduced from weeks to near-realtime, with 95% of registrations automated.
  • Provider requests to join the plan’s networks approved in WEEKS instead of months.
  • 100% of contracted in-network providers notified to verify their directory information.
  • More than 50,000 updates to demographic information by contracted providers (annualized 12-month run rate).
  • Projected staffing reduction of 13 FTEs, a 16% reduction.
< $500,000

Total Spent

> $1,600,000

1st Year Projected Savings

300%

Total 1st Year ROI

Solution

Providers use the Availity Provider Engagement Platform to register with the health plan, request to join the health plan’s networks, and maintain their demographic information. The same platform is the health plan’s preferred method for exchanging HIPAA transactions, clinical data, and risk and quality information, so when providers receive personalized notifications about the status of their transactions or requests by the plan for information, they are able to complete their tasks without changing applications, which boosts adoption.

“Provider data feeds the majority of our core processes. If provider data is accurate, it enables automation, efficiency, and improved provider self-service throughout the continuum of the healthcare experience”

Health Plan Senior Director of Provider Engagement and Enablement

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