Availity News

Availity Supports Simplifying Prior Auth Process


3.13.2018 By AVAILITY

Availity’s aligned with the healthcare industry’s goal of providing safe, timely and affordable patient care


Jacksonville, FLA.—March 13, 2018Availity, the nation’s largest real-time health information network, praised the recent announcement by physicians, pharmacists, medical groups, hospitals and health plans to streamline the prior authorization processes.

In January, the American Hospital Association (AHA), America’s Health Insurance Plans (AHIP), American Medical Association (AMA), American Pharmacists Association (APhA), Blue Cross Blue Shield Association (BCBSA) and Medical Group Management Association (MGMA) released a Consensus Statement outlining their shared commitment to industry-wide improvements to prior authorization processes and patient-centered care.

The current means for obtaining prior authorizations is burdened by inefficient and labor-intensive manual processes, steep claims denial rates, and patients frustrated with delayed medical treatments or unexpected medical bills. The Consensus Statement includes several practical steps to mitigate the inefficiencies associated with the pre-approval health plans require for many healthcare services.

“It’s exciting to see so many major stakeholders align around the common goal of eliminating these inefficiencies,” said Russ Thomas, Availity CEO. “Accelerating the industry’s adoption of national electronic standards for prior authorization is timely, because more payers are including electronic transaction capabilities in provider contractual agreements. By automating the approvals process, providers and health plans are able to deliver timely care to patients more efficiently and effectively.”

According the 2016 CAQH Index, an annual report of the adoption of electronic business transactions, provider organizations could save more than $412 million by adopting automated, electronic authorizations.

In the past year, Availity has made significant moves to position both providers and payers to capitalize on the adoption of electronic authorizations and other transactions.

  • In April 2017, Availity announced the launch of its automated prior authorization solution, a HIPAA-compliant, secure cloud platform that streamlines front-office workflow, allowing office staff to eliminate fax- and web-based tasks in favor of real-time electronic submission of authorization requests, reducing the prior authorization process from weeks to minutes.
  • In July 2017, Availity secured a new $200 million revolving credit facility to develop and acquire high-quality assets within the company’s payer and provider segments.
  • In September 2017, Availity announced a significant growth equity investment led by Francisco Partners, a leading technology-focused private equity firm, fueling the company’s ability to deliver on inorganic and organic growth opportunities.

In addition to automated authorizations, Availity’s deep experience in patient financial health, including its Patient Access platform, delivers to providers a seamlessly integrated solution for helping patients understand their insurance coverage and financial obligations.

“Availity is driving systematic change and standardization as the designated nexus of communication between 1.2 million active providers and a network of national and regional health plans across the country,” said Thomas. “As a result, we are well positioned to shape a 21st century healthcare system that is both cost-effective and patient-centered.”

About Availity

As an industry-leading, HITRUST-certified health care information technology company, Availity serves an extensive network of health plans, providers, and technology partners nationwide through a suite of dynamic products built on a powerful, intelligent platform. Availity integrates and manages the clinical, administrative, and financial data needed to fuel real-time coordination between providers, health plans, and patients in a growing value-based care environment. Facilitating over 10 million transactions daily, Availity's ability to provide accurate, timely, and relevant information is vital to the financial success of its clients.

For more information, including an online demonstration, please visit www.availity.com or call 1.800.AVAILITY (282.4548).


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