Seamlessly connect to providers and vendors nationwide
Availity’s Intelligent Gateway is the exclusive network for health plans representing 75 million covered lives. Our connectivity to clearinghouses and third-party vendors nationwide allows you to submit and receive critical information through integration with their practice management, hospital information systems, and EHRs.
Transactions and Modes
Availity processes all HIPAA and non-standard EDI transactions via multiple modes, including batch, real-time REST APIs, real-time SOAP web services, as well as Direct Data Entry through Availity Essentials.
Learn more about our clinical capabilities.
Stop bad claims from reaching your adjudication system and starting the “prompt-pay” clock. Availity Editing Services is a batch claims evaluation tool that delivers standard edits, including HIPAA compliance and some payer-specific edits, and premium edits, which are built using data outside a transaction.
Availity Insights is a robust reporting solution that puts analysis and troubleshooting in your hands. This flexible tool gives you a deep dive into detailed, transaction data elements, allowing you to build your own custom reports.
Coverage Identification Solution
Eligibility inquiries from coverage identification tools can slow down network traffic for providers who need real-time information. Availity works with you to design a strategy that delivers the coverage information providers need without sacrificing network performance.
Learn how Availity helped one health plan improve real-time network performance.
Migration and Contracting
Availity’s extensive experience migrating payers means you have the expertise needed to transition your provider network with minimal disruption. We can also assume responsibility for managing trading partner contracts, giving you just one point of contact for EDI-related issues.
Availity helps streamline claim processing and other administrative processes that still rely heavily on paper forms. Offload manual, time-consuming processes with drop-to-paper, paper-to-electronic conversion, mailroom services, and more.
If your legacy back-end systems don’t support x12, Availity can convert proprietary remittance format to x12 835 and premium payments to x12 820. Conversely, we can receive x12 835 and 820 files from providers and vendors and convert them to your proprietary format.