Availity Revenue Cycle Management delivers full-cycle revenue cycle capabilities, streamlining pre-service, post-service and post-adjudication workflows
As healthcare operations become more complex, hospitals and medical practices need advanced revenue cycle management solutions that automate workflows, reduce claim denials, and accelerate reimbursements—without increasing administrative burdens or disrupting existing systems.
Availity Revenue Cycle Management (RCM) is a full-cycle revenue cycle solution that helps provider organizations streamline revenue cycle operations throughout all three phases: pre-service, post-service, and post-adjudication.
Leverage Availity’s secure by design environment to gain peace of mind on your organization’s ability to recover rapidly from cyber-attacks
Become part of Availity’s dual-sided network and reach the most nationwide payers directly, reducing transaction delays
Automate tasks that previously required manual intervention and prevent denials before they happen
Create a curated, end-to-end experience by seamlessly integrating new solutions into RCM workflows, eliminating siloed experiences
Strong pre-service workflows help healthcare organizations prevent claim denials by ensuring the right information is captured upfront. Availity RCM helps providers streamline insurance eligibility verification, ensure accurate coverage detection, and secure prior authorization directly within their EHR. Our automated pre-service tools include:
Incomplete or inaccurate patient information slows down the delivery of care and increases the chance of denials. Availity RCM helps providers get fast, accurate and near real-time patient coverage without leaving the EHR.
Providers want to receive the most up-to-date eligibility information directly in their workflow. With access to Availity’s nationwide, dual-sided network, providers can receive real-time eligibility and benefit information directly in their workflow.
Providers spend too much time manually managing prior authorizations—from calling a payer to find out if an authorization is required, submitting the authorization via fax, or calling the payer to check the status. Availity RCM connects directly to payers, helping automate the submission process to get care decisions faster.
Patient Financial Clearance, Financial Assistance Scoring, Address Verification, Medicaid Redetermination, Patient Estimates, Propensity to Pay and Credit Scores
Coverage Locator, Advanced Real-Time Eligibility, 270/271 Batch Eligibility, Self-Pay Eligibility Check, Interactive Eligibility (DDE), Pre-Claim Eligibility, Patient Financial Profile
Provider Authorizations, 278 Notice of Submission, EDI Enrollment
Manual claim management processes slow down reimbursements, increase denial rates, and create administrative burdens for providers. Availity RCM’s AI-powered automation and predictive claim editing capabilities streamline electronic claim processing, reduce errors, and enhance financial insights—helping improve revenue cycle performance. Our advanced post-service solutions include:
Availity RCM allows providers to electronically submit many types of claims, including primary and secondary paper claims.
Because payer rules change often, claim editing can be a time-consuming and costly process. Availity RCM’s AI-driven predictive editing analyzes claims before they are sent to the payer, allowing providers to manage, correct and submit cleaner claims to reduce back-end denials and get paid faster.
Providers spend too much time calling payers to find out whether a claim has been accepted, denied, or paid. Availity RCM helps providers get claim status and history in real-time and in one place.
Providers often have incomplete or inaccurate clinical documentation that leads to denials and burnout amongst Clinical Documentation Improvement (CDI) teams. Optimize clinical documentation integrity by automating and enhancing the collection process and identify patient charts, and medical records that have the highest potential for financial or clinical improvement.
Claim Electronic Attachments, Automated Claim Status, Medicare Enhanced Claim Status, Real-Time Claims Editing, Worker’s Compensation Claims, Claims Editing, Batch Claims (837), Interactive Claims Submission (DDE)
ACE Claim Edit and Rule Creation, Predictive Editing, CDM Revenue, Integrity
Advanced Claim Status, Real-Time Claims Status, Claim DTP, Auto Status, Claim Errors (276/277/CRD).
Clinical Documentation Integrity (CDI), Chargemaster Management.
Denied claims create administrative backlogs, lost revenue, and delays in provider payments. Availity’s RCM features denial management tools to identify claim denial patterns, streamline appeals workflows, and accelerate revenue recovery. Our post-adjudication solutions include:
Providers often manually review and process remits, which drives increased administrative burden and errors. Availity RCM automates delivery of remittance files, and manages missing remits, and matches remits back to the claim in real-time.
High denial volumes overwhelm revenue cycle teams and delay care or reduce reimbursement. Availity RCM automates the creation and management of claim edits, and leverages AI to identify potential claim denials before they go to payers.
Billing teams spend significant time chasing unpaid bills. Availity RCM simplifies the patient payment process with automated workflows that streamline the entire process—from statement delivery to payment posting.
RCM leaders often lack the visibility into the underlying data of their operations and are left to make decisions by instinct or gut feel. Availity RCM helps reduce time spent gathering data, enhance decision-making with data-driven insights and filter data against RCM goals with both executive and user-level analytics.
Electronic Remittance Delivery and Claim Matching, Paper EOB to 835 Remittance Advice Transformation, Remittance Auto-Posting (835), Lockbox, EFT Reconciliation, Remit Replication
Denial Prevention and Management Module, Appeals Form API, Electronic Attachments
Patient Statements, PersonaPay, eStatements, ePayments
Cloud-Based Analytics and Dashboard Reporting, Rev Cycle Assistant
Solution
Verify your patients’ eligibility and coverage information through a trusted partner.
Solution
Discover how Availity’s robust revenue cycle tools support denial prevention and management, reducing write-offs and optimizing cash flow.
Product
Boost efficiency, prevent denials, expedite payments with Availity Essentials Pro End-to-End RCM.
Product
Learn how Availity can help your health plan streamline provider workflows and improve collaboration.
Product
Learn how Availity can help you reach more health plans while streamlining pre-service and billing.
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