Dynamic technological innovation with in-depth understanding of the healthcare industry

Availity optimizes the flow of information between multiple health care stakeholders through a single, secure internet-based exchange. The Availity Health Information Network can benefit all health care providers, including: Physician offices, from single providers to multi-specialty practices, Hospitals and integrated delivery networks, Pharmacies, Laboratories, imaging centers, and other ancillary providers.

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Solution Principles

  • Provide standard transactions at no or minimal cost to providers and other end users
  • Receive payment from back-end channel partners, including payers
  • Provide administrative, clinical, and financial information exchange on a regional basis
  • Support web, business to business (B2B), and electronic data interchange (EDI) transmission options, in both real-time and batch, enabling stakeholders to share data consistent with the level of complexity of their own back end systems
  • Support a federated, real-time data model, enabling data "owners" to maintain their own data
  • Support regulatory compliance initiatives, including HIPAA, ASTM X12, HL7, ASTM Continuity of Care Record (CCR), and CAQH CORE
  • Invite other stakeholders, including payers and vendors, to join the Availity network

Administrative Solutions

  • Commercial Health Plan Transactions: Eligibility and Benefits Inquiry, Health Care Services Review (Authorization and Referral Submission), Health Care Services Inquiry (Authorization and Referral Inquiry), Claim Submission, Claim Status Inquiry, and Remittance transactions are supported for multiple health plans. Availity supports real-time claims adjudication when supported by the health plan.
  • Government Health Plan Transactions: Claims, Online Claim Correction, and real-time Eligibility and Benefits for Medicare and Medicaid plans are available in select regions.
  • CareReadSM: Swipe patients' magnetic stripe-enabled member ID cards through a three track card reader connected to the computer to automatically populate the fields on Availity web transaction pages. This eliminates the need to manually key the information, avoiding data entry errors and streamlining provider workflow.

Clinical Solutions

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  • CareProfileSM: Access electronic health records, currently sourced by claims-based information from multiple health plans. A consolidated view of patients' health care services across physicians and providers helps improve patient safety, eliminates duplicate medical procedures and aids in reducing unnecessary services and fraud.
  • Patient Communication: Securely connects physicians and patients online and supports patient-initiated appointment and referral requests, normal lab and test result sharing, physician-initiated targeted preventative care reminders, online medical evaluations for non-urgent health matters or symptoms, and customizable practice and patient education newsletters.
  • CarePrescribeSM: An electronic prescribing solution that provides access to up-to-date patient-specific medication history and coverage, therapeutic equivalent and lower cost alternative options, and real-time drug-drug interaction checks.

Financial Solutions

  • CareCost EstimatorSM: Determine a patient's financial responsibility in real-time at the point of care based on member benefits, provider contractual allowances, deductibles, and benefit maximum accumulators at the time of inquiry.
  • CareCollectSM: Collect patient responsibility via card swipe, including combination member ID cards for high deductible plans, debit cards, and credit cards.

Transmission Options

  • Web: Customers log on to the Availity Health Information Network, a secure web portal, and transact in real-time.
  • Business to Business (B2B): Customers conduct real-time transactions through their own system. Although Availity retrieves the information, it is transparent to the user.
  • Electronic Data Interchange (EDI): Customers create batch transactions in their own system. This functionality can be transparent to the user if their system vendor offers a seamless solution. Availity also offers users the ability to log onto the portal to upload batches directly.

Availity Benefits

  • Accessible. Availity functions are available 24 hours per day from any computer with Internet access, offering you the freedom to work anywhere, anytime.
  • Availity is committed to supporting the Health Insurance Portability and Accountability Act (HIPAA) regulations for privacy, security, and electronic transactions.
  • Secure. You can trust the secure movement of confidential health care information through the Availity Health Information Network. Availity requires browser versions that support 128-bit encryption, the strongest form of security available today.
  • Supported. The Availity Client Service Center is available Monday through Friday, 8:00am to 7:00pm EST to answer your questions. Comprehensive help and tutorials are available online as well.

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13301 SW 132nd Avenue, Suite 109 Miami, FL 33186

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