Streamline end-to-end prior authorizations

A prior authorization isn’t a simple inquiry and response transaction. It’s a complex conversation between payers and providers. End-to-End Authorizations on the Availity Platform delivers a fully integrated, CMS-compliant solution that not only streamlines authorization submissions across all provider channels but leverages responsible AI to help care managers make fast and accurate determinations on the appropriateness and the timeliness of care.

Foundation

Support flexible and configurable authorization routing

Payers have many different rules that govern how and where authorizations are transmitted based on many different factors, including the submitting provider, the specialty, the presence of a delegated utilization management vendor, and many more. Availity’s multi-payer platform offers the flexibility and configurability you need to efficiently manage authorization routing.

Submission

Streamline authorization submissions through all provider channels

With a platform approach, Availity serves as the front door for all provider authorization submissions through all channels, including portal, trading partners, and direct X12 or API connections.

Availity supports the CMS-mandated FHIR-based approach and meets payer requirements in alignment with the HL7® DaVinci Implementation guides: Coverage Requirements Discovery (CRD), Documentation Template & Payer Rules (DTR), and Prior Authorization Support (PAS).

Determination

Automate up to 80% of the utilization management workload

Availity allows care managers make determinations quickly and accurately by eliminating the manual review process, harnessing the responsible use of AI to deliver speed and accuracy to medical necessity reviews, and automatically extracting clinical data from medical records.