Driving interoperability in healthcare

One of the best ways to reduce waste in healthcare is to improve the sharing of clinical and administrative data across the ecosystem. Availity works with payers and providers, along with organizations such as Health Level Seven International® (HL7®) DaVinci Project and the Workgroup for Electronic Data Interchange (WEDI), to help transform data-sharing capabilities and reduce the cost of care.

Deliver nationwide administrative connectivity

Availity has long been the trusted intermediary for payers, providers, and trading partners to exchange data, ensuring patients receive timely access to care and helping providers receive payment quickly and accurately. Availity helps:

• Facilitate the exchange of core HIPAA administrative transactions, including eligibility and benefits (X12 270/271), claim submission (X12 837), remittances (X12 835), claim status (X12 276/277), and prior authorization (X12 278). 
• Ensure compliance with the CMS Prior Authorization API (FHIR®). 
• Support emerging connectivity standards, including REST and FHIR APIs.

Streamline the acquisition of member data for payer-to-payer compliance

The Payer-to-Payer Exchange mandate in CMS’ Interoperability and Prior Authorization Final Rule requires select payers to share member data at the member’s request. Availity’s Payer-to-Payer Hub solution is helping payers meet this mandate and improve member experience by:

• Establishing secure connections with payers to send and receive member data 
• Reducing data sharing risks and effectively manage new members 
• Optimizing care coordination and avoid duplicate tests and services

Improve the quality of clinical data for downstream workflows

Clinical data gives payers and providers insight into an individual’s health journey, but in its raw form, it’s often incomplete, redundant, and inaccurate. Availity’s Upcycling Data technology, Availity Fusion™, converts clinical data into FHIR formats and improves the quality the data, allowing it to be used across multiple use cases.