Availity ‘Shifts Left’ on Prior Authorizations at Vive

Jacksonville, FL – February 14, 2025 – Availity, the nation’s largest real-time health information network, takes the stage at the Vive conference in Nashville to discuss technology strategies for streamlining the burdensome prior authorization process.

Availity Vice President of Strategy & Partnerships Samantha Murphy will join a panel discussion called ‘Prior Authorization: It’s Me, Hi, I’m the Problem, It’s Me’ on Monday, February 17, on the Rock-n-Roll Stage at Vive. She will be joined by Billy Deitch, Partner, Oak HC/FT; Dr. Rasu Shrestha, Chief Innovation and Commercialization Officer, Executive Vice President at Advocate Health; Christie Callahan, Chief Operating Officer at Arrive Health; and Dr. Aisha Rahim, Medical Director at Johns Hopkins Health Plans.

The panel will engage in a lively conversation about how innovations in artificial intelligence and automation can transform the antiquated and manual-based processes of prior authorizations.

Empowering Providers and Payers Through Innovative Technology

In an increasingly complex healthcare environment, Availity brings decades of experience as a technology innovator, providing solutions that facilitate real-time digital healthcare interactions via its connected network of providers, payers, and partners. As a pioneer in multi-channel digital engagement, Availity’s API-powered approach simplifies and adds intelligence to critical healthcare interactions – taking aim at inefficient and burdensome administrative and clinical processes, such as prior authorizations.

“Availity’s platform empowers providers and payers to make faster, more informed decisions while reducing abrasion and lowering costs,” said Murphy. “We are excited to engage with Vive attendees and demonstrate how Availity’s approach simplifies healthcare workflows, reduces operational burdens, and improves outcomes across the healthcare ecosystem.”

A platform approach to transforming utilization management

Availity’s intelligent utilization management solution is a CMS-compliant, AI-powered offering that automates every stage of the authorization process—from clinical data collection and submission to near real-time determination. This approach reduces provider abrasion and empowers payers to shift their focus from simply managing volumes and turnaround times, into a more strategic focus on care optimization. The ultimate end goal is to ensure patients have access to the right care at the right time in the right place.

“Our strategic focus and investment in utilization management solutions is being driven by multiple factors, including the 2027 deadline for the CMS Interoperability and Prior Authorization Final Rule,” said Sean Barrett, Availity’s Chief Product Officer. “Availity wants to go beyond just checking the box on compliance to truly transforming the authorization process.”

The solution’s key components include:

• Translation Architecture allows Availity to act as an intermediary, translating provider submissions to a format payers can process in accordance with the CMS mandate 
• Network Integration supports a build-once, expose-to-multiple-channels model
• Proprietary AI-Clinical Engine uses a non-predictive AI model to ingest and analyze health plan medical policies against clinical data extracted from the patient record
• Assisted Auth Review workflow leverages the AI engine to analyzes prior authorization cases based on available clinical information and make a Yes/No or True/False assessment for medical necessity
• Utilization Management Review workflow leverages the AI engine to bring forward questions that need clinical input to determine medical necessity. Information is presented in a decision-tree form that is easy to review and aligns to relevant criteria

Availity’s Innovation in Prior Auths

Availity has been recognized in the industry for its innovations in prior authorizations and utilization management.

Last year, the company was recognized with a 2024 KLAS Points of Light Award for its collaborative work to develop an automated prior authorization process leveraging the Da Vinci Burden Reduction Implementation Guides – a set of standards designed to make the process of prior authorization in healthcare more efficient and streamlined – to expedite approval of these requests and deliver a better, more seamless end-to-end experience for patients, providers, and payers.

Key outcomes of the collaboration include quicker patient access to care, improved provider efficiency, and decreased administrative burden versus previous manual processes. Stakeholders determined that during the evaluation period, nearly 54% of all requests required no authorization, and 70% of prior authorization requests processed through the implementation were instantly approved by the payer, due to the integration that enables robust data gathering and sharing. These instant approvals have contributed to a dramatic reduction in turnaround time from multiple days to about one day, which far exceeds industry averages that can range from days to weeks, and also outperforms the seven-day target established by the CMS Interoperability and Prior Authorization Final Rule.

About Availity

Availity empowers payers and providers to deliver transformative patient experiences by enabling the seamless exchange of clinical, administrative, and financial information. As the nation’s largest real-time health information network, Availity develops intelligent, automated, and interoperable solutions that foster collaboration and shared value across the healthcare ecosystem. With connections to over 95% of payers, more than 3 million providers, and over 2,000 trading partners, Availity provides mission-critical connectivity to drive the future of healthcare innovation. For more information, including an online demonstration, please visit www.availity.com or call 1.800.AVAILITY (282.4548). Follow us on LinkedIn and X.

Media Contacts:

Matt Schlossberg
Director of Public Relations, Availity
630-935-9136
[email protected]