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As high-deductible health plans and other out-of-pocket health costs proliferate, hospitals and medical groups struggle to develop strategies that improve cash flow and satisfy patients. Availity's Kristina Hutson shares providers' best opportunities to do both.

Provider directory management (PDM) can be a significant and expensive administrative burden for health plans and providers. Although the healthcare industry spends nearly $3 billion annually to maintain provider directories, they are notoriously inaccurate.

Joint technology solution will deliver an integrated data interoperability platform that streamlines data acquisition and delivers clean, actionable, and intelligent data.

Availity’s foundation—and reputation—is built on decades of innovation in revenue cycle management and administrative and financial workflow improvements between health plans and providers. All in the interest of the ultimate consumer—the patient.

We know Zoom can’t take the place of getting together on Amelia Island. Still, it does allow us to stay in touch as we continue the work of improving payer-provider collaboration.

After a two-year pause due to the pandemic, Availity Connects returned. More than 227 friends, customers, and colleagues from health plans, vendor partners, and provider organizations across the country reunited on Amelia Island, FL, to define healthcare’s path forward in the new normal.

Value-added transaction capability delivers a dynamic provider experience, helps reduce administrative inefficiencies, and accelerates Availity’s omni-channel strategy

As the product line manager for Availity Editing Services, I talk with a lot of health plans about how they can improve their clean claim rate by taking advantage of the editing capabilities in Availity’s Intelligent Gateway.

Availity, the nation’s largest real-time health information network, announced today that Bobbi Coluni has joined the company as chief product officer (CPO). In her role, Coluni is responsible for leading Availity's product design and management, developing innovative solutions, and launching products for the healthcare market.

Availity, one of the nation’s largest real-time health information networks, is proud to be Certified™ by Great Place to Work® again. The prestigious award is based entirely on what current associates say about their experience working at Availity. In a survey from Great Place to Work, 94% of Availity associates said it’s a great place to work – 35 points higher than an average U.S. company.

The No Surprises Act legislation, which is scheduled to go into effect on January 1, 2022, is a complex piece of legislation that will significantly impact health plans, providers, and patients in 2022 and beyond. To help our stakeholders better understand the law and prepare for its implementation, we chose it as a topic for our last Availity Connects, Virtual session...ppp

Jacksonville, Fla—October 19, 2021— Availity, one of the nation’s largest real-time health information networks, announced today that Jim McNary has joined the company as chief operating officer (COO). As COO, McNary is responsible for leading cross-departmental operations, refining business processes, and maintaining alignment throughout the company for both organic and inorganic initiatives. Availity’s technology, product management, implementations, and strategy/corporate development teams will report to McNary.

Jacksonville, Fla—July 20, 2021— Availity, one the nation’s largest real-time health information networks, announced today that Frank Petito has been appointed chief financial officer. In his new role, Petito is responsible for leading Availity’s financial and accounting teams and serves as a strategic partner to the organization’s board of directors and executive leadership team regarding organic expansion, mergers and acquisitions, and capital markets opportunities.

July 7, 2021 -- Novo Holdings A/S (“Novo Holdings” and “NH”), a leading international investor in healthcare and life sciences, today announced a strategic minority investment in Availity, one of the largest healthcare data and administrative networks connecting payers and providers throughout the United States.

Jacksonville, Fla—June 8, 2021— Availity, the nation’s largest real-time health information network, named healthcare and business development veteran Leslie Antunes as its chief growth officer. Antunes will be responsible for driving strategic growth initiatives and leading the business development, sales, client services, marketing, trading partner, account and alliance management teams.

Lillian Phelps, Senior Director of Product Management, Availity shines light on the new HHS rules about price transparency for hospitals and health plans. These organizations now need to publish their standard rates as well as their contracted rates along with pricing for bundled services for over 70 specific services. As the nation's largest health information network, Availity works with providers and health plans to enable real-time generation of understandable data for patients and healthcare providers to inform better medical decisions.

Availity, the nation’s largest real-time health information network, announced today that it has earned the honor of becoming a Great Place to Work-Certified™ company, a distinction rooted in the tremendous talent, energy, and generosity of its associates.

Availity, the nation’s largest real-time health information network, and Regence, a family of regional health plans serving members in Oregon, Washington, Idaho and Utah, announced today the results of their collaboration to improve the pre-authorization process through the implementation of new tools that allow for real-time, electronic and automated pre-authorization.

First, the good news: While a new federal mandate requiring health plans to build an online shopping tool for members will be a heavy lift for some payers, most major health plans already offer online cost estimator tools. That will give them a leg up compared to payers that will have to build tools from scratch, according to industry experts.

With a $100,000 donation from Availity to establish the Availity Nurse Practitioner Scholars Fund at Jacksonville University, qualified nurse practitioners (NPs) may begin to earn the educational credits needed to offer independent primary care without an attending doctor, as outlined under a new state law.

In theory, health care consumerism is a straight-forward idea: Shifting costs to consumers, typically in the form of high-deductible health plans (HDHPs), gives them an incentive to make informed decisions about the health care services they purchase. In practice, consumerism represents a significant challenge to providers’ bottom lines. A recent report reveals that for 74% of providers, patient collections take over a month. Further, 66% of providers said patient receivables are a primary revenue concern. Part of the problem is many providers’ patient collection processes do not align with consumer preferences. For example, 88% of providers reported relying on manual and paper-based transactions for patient collections, but 46% of consumers prefer electronic communication for medical bills, while 65% prefer to pay medical bills via online portals or mobile apps.

In January of 2018, the American Medical Association, along with stakeholders from many other payer and provider organizations, released a consensus statement on the importance of reforming the prior authorization process. Almost two years later, however, the news doesn’t seem to be improving. A recent report published by Medical Group Management Association (MGMA) found that medical group practice leaders believe their regulatory burden, particularly prior authorizations, is getting worse, not better.

In a recent interview with HIMSS TV, Russ Thomas discussed how Availity led conversations with providers and health plans during COVID-19 to ensure that the latest information needed for processing claims and billing was being shared between both parties.

Telemedicine is finally having its moment. It’s long been viewed as a potential way to reduce healthcare costs and drive better coverage among underserved areas, but utilization hasn’t kept pace with expectations. According to Peterson-KFF Health System Tracker, in 2018, 2.4% of large group enrollees who had an outpatient office visit had at least one telemedicine visit, which was up from 1.6% in 2017...

Availity, the nation’s largest real-time health information network, announced today that it has launched a COVID-19 Provider Resource Center that consolidates links to updates from more than 50 payers for information about patient eligibility, coding, claims processing, telehealth guidelines and more. The new COVID-19 Provider Resource Center connects providers directly to payer updates, while enabling better collaboration between providers and payers...

Availity, the nation’s largest real-time health information network, named Frank J. Manzella its new Senior Vice President of Corporate Development & Strategy. An experienced healthcare executive and investor with broad strategic expertise and transaction experience, Manzella’s focus will be to provide critical insights and guidance for potential acquisitions designed to significantly expand Availity’s capabilities ...

Sixty-seven percent of all provider organizations in the United States attest the accuracy of their provider directories, credentialing, and other demographic data through the industry-leading, multi-payer intelligent portal of Availity, the nation’s largest real-time health information network. So far this year, 263,000 provider organizations, representing almost 1 million physicians, utilized Availity to make more than 7 million updates or corrections to their directories.

Availity helps healthcare providers and health plans connect, making it easier to share clinical, financial, and administrative information. We value your business and respect the security of your patient data, which is why we’re introducing additional authentication measures.

Jacksonville, Fla—June 18, 2019— Black Book Market Research LLC awarded Availity, the nation’s largest real-time health information network, its highest ranking for Ambulatory Claims Management and Physician Clearinghouse Solutions, in a comprehensive survey of more than 1,600 hospital and health system executives, directors, and managers.

There’s a fun phrase about dental practices: “When the front office hums, the back-office dances.” How does the front office hum? Let me paint you the picture—the front office staff is answering phones, greeting patients who walk in, and working their daily schedule.

In theory, healthcare consumerism is a straight-forward idea: Shifting costs to consumers, typically in the form of high-deductible health plans (HDHPs), will give them an incentive to make informed, judicious decisions about the healthcare services they purchase. In practice, consumers have been slow to shop for health care based on price, despite high enrollment levels in HDHPs, with the National Center for Health Statistics reporting that nearly 40 percent of consumers purchased private HDHPs in 2016, up from 26 percent in 2011.

Starting Monday, Jacksonville-based Availity LLC and about 400 employees will operate at its new headquarters offices at Town Center One. Until then, most employees will work from home as the move is completed to the newly constructed building at 5555 Gate Parkway, across Butler Boulevard from St. Johns Town Center.

Health plans are committed to reducing waste and inefficiency, but the healthcare industry as a whole still spends too much time and money manually managing administrative transactions. One report found that faxes account for almost 75 percent of all medical communication, and the 2017 CAQH report predicted administrative costs would reach $315 billion by the end of the year. These costs are driven largely by the continued reliance on phone calls, fax, and mail to manage claims transactions.

Availity, the nation’s largest real-time health information network, named Damien Creavin its new Chief Technology Officer. Availity’s New Chief Technology Officer Brings a Fresh Perspective to Healthcare.

CMS’s recent report on the state of provider directories identified three challenges facing health plans. Recent blogs covered the first two challenges: the issue of contractual versus resource constraints and the lack of internal audits by health plans to verify provider information. A third problem creating directory inaccuracies is that health plans rely on providers to reach out and tell them when information changes. From the report: “MAOs cannot assume that they will be informed when a change in provider location occurs; instead, MAOs need to implement routine processes that drive more accurate information reflected in their directories.”

The second problem CMS identified in its report on provider directories was a lack of internal audits by health plans to verify provider information. The report faulted health plans for outsourcing the audit process, stating “Medicare Advantage Organizations (MAOs) placed full faith in credentialing services and vendor support, and even in provider responses...” and “if MAOs had implemented routine oversight of their processes for data validation, errors in the provider directory would have become apparent.”

The RISE conference in Nashville was a great opportunity to learn about new approaches to analytics and member engagement, as well as to hear about many of the creative initiatives health plans are implementing to improve quality scores and meet the complex web of risk adjustment requirements for Medicare Advantage, ACA, and Medicaid.

The Integrated Healthcare Association (IHA) announced their selection of Gaine Healthcare and Availity as the technology vendors for the launch of the statewide Provider Directory Utility (PDU). The first of its kind in the state, the PDU will offer a centralized, cloud-based platform for providers and health plans to update, manage, and exchange their provider data.

What’s the current state of payer-provider collaboration, and what does the future hold? Big questions to be sure, but we tried to find answers during a recent Availity-sponsored SmartBrief webinar featuring healthcare industry expert Jay Eisenstock of JE Consulting.

Availity, 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.

CMS has identified three drivers of directory deficiencies: group vs. provider-level data, lack of internal audits, and reliance on provider-led notifications. We've outlined these issues in an infographic.

In its second annual report on the state of provider directories, the Centers for Medicare and Medicaid Services (CMS) found that 46 percent of all directory entries reviewed contained at least one error that makes it difficult for patients to find doctors in their networks.

Thanks to a new relationship with Availity, LLC, Amedisys, Inc, one of the nation’s leading home health, hospice and personal care providers, is processing authorizations more efficiently – and less costly. Previously, Amedisys processed every authorization for managed care claims manually, through either a website or a phone call, requiring 15 to 20 minutes per claim. As a result, authorizations often took too long to complete, thus raising administrative costs and at times, delaying patient care. To address those longstanding challenges, Amedisys forged a relationship with Availity, the nation’s largest real-time health information network. Availity electronically synthesizes and shares data in real-time between providers and health plans nationwide.

Recently, three trends have aligned to signal highly favorable conditions in the independent radiology space for the coming year. These trends are: (i) a resurgence of the patient steerage debate; (ii) an increase in patient consumerism; and (iii) advances in pre-service technology that could significantly improve practice efficiency. Independent radiology centers that take steps now to prepare will be in an enviable position next year and better able to capitalize on these trends.

Florida Gov. Rick Scott presented the Governor’s Business Ambassador Award to Availity, the nation’s largest real-time health information network, for Availity’s contributions to Florida’s economic vitality. The Governor’s Business Ambassador Award is given to individuals and businesses in recognition of their efforts to create jobs and opportunities within the state. Founded in Jacksonville in 2001, Availity employs more than 400 Floridians, and has created 130 new jobs in Florida in just the past two years.

Availity understands that if you want to drive provider engagement, you need to find new ways to automate healthcare transactions. That’s why we are introducing two new automated workflows within our Provider Engagement Portal: appeals and overpayments.

In this edition of Availity Access, Mark Martin, product line director for provider data, discusses why addressing credentialing is the next logical step in Availity’s work to simplify data verification and improve the quality of provider data throughout the health care data ecosystem.

Working in healthcare guarantees you’ll be interrupted multiple times a day, whether it’s by staff, patients, physicians, or health plans. Fortunately, there are some tasks that can be completed on your timeline. Even better, when you get ahead of them you can greatly reduce the number of interruptions you face.

Availity recently commissioned an independent research company to survey providers—physicians and non-medical staff, in practices and facilities—about their credentialing process. No one should be surprised that providers are not happy with how it’s conducted.

Availity, the nation’s largest real-time health information network, announced today that it has received a significant growth equity investment led by Francisco Partners, a leading technology-focused private equity firm, with additional investment from Availity’s existing investor group.

Recognizing the need for greater automation, the CAQH Committee on Operating Rules for Information Exchange® (CAQH CORE®) brought entities from across government and the industry together to develop healthcare operating rules for electronic business transactions.

Availity today announced its recognition as one of the Achievers 50 Most Engaged Workplaces™ in North America. The annual award, issued by Achievers, an industry leading provider of employee recognition and engagement solutions, commends top employers that display leadership and innovation in engaging their workforces.

In our latest vlog series, Mohammed Ahmed, Availity’s Vice President of Authorizations Sales Enablement, provides insight into the key features and functions you should look for in an automated authorization solution.

In our latest vlog series, Mohammed Ahmed, Availity’s Vice President of Authorizations Sales Enablement, provides insight into the key features and functions you should look for in an automated authorization solution.

In our latest vlog series, Mohammed Ahmed, Availity’s Vice President of Authorizations Sales Enablement, provides insight into the key features and functions you should look for in an automated authorization solution.

Two things health plans and providers can agree on are the importance of improving patient satisfaction and lowering administrative costs. They also know that increased communication and collaboration are necessary to achieve these goals. The challenge is that neither health plans nor providers have made improving communication a business priority.

Understanding the needs of customers is paramount to any business’s success. And for Availity, a long-time, trusted intermediary between health plans and providers, understanding and appeasing both segments of the healthcare market has its challenges. Despite the development of integrated digital tools and improved processes and workflows, the relationship between these healthcare stakeholders is historically influenced by friction—even though both recognize a need to work together.

Although collaboration between payers and providers will be critical if they are to succeed in transitioning to value-based payment models, they continue to struggle with information exchange in the current fee-for-service environment. That’s the finding of a new survey of 40 health plans and more than 400 practice- and facility-based providers, which found significant communication gaps between the stakeholder groups.

A survey conducted by Availity, the nation’s largest real-time health information network, found that while payers and providers want to collaborate more closely on value-based care initiatives, such partnerships remain vulnerable to poor data transparency, competing business goals, and significant administrative burdens.

Healthcare industry trends such as growth in data analytics and high-deductible health plans are causing payer and provider relationships to evolve. With this evolution comes the need for greater communication and collaboration between the two sides. A recent Availity survey of 40 health plans and 400 practice- and facility-based providers found 53 percent of payers "strongly agree" providers and health plans need to collaborate to be profitable.

Mark Martin, Director, Payer and Vendor Portfolio at Availity, the nation’s largest real-time health information network, will take part in a panel discussion titled “Solving the Inaccuracy and Inadequacy of Provider Directories” at WEDI 2017, May 15-18, in Los Angeles.

In an era of shrinking reimbursements, it's more important to capture every dollar owed to your practice as far forward in the process as possible. It's a matter of time and money. According to a 2016 Kaiser Family Foundation study, average deductible and co-insurance costs have seen the biggest increases between 2004 and 2014, and continue to grow while copays are continuing to decline. The shift toward high deductible health plans has fueled that rise.

Availity, the nation’s largest real-time health information network, announced the launch of its automated prior authorization platform, which eliminates the cost, time, and administrative burdens associated with manual authorization processes.

Join us Friday, 4/14 at 1pm ET for our Assessing Quality Measures tweetchat featuring our own Risk Queen, Susan Bellile (@SKB_RnQ), and The Healthcare IT Guy, Shahid Shah (@ShahidNShah), as we discuss the current and future role of quality measures through technology, legislation, and innovation.

Last year, Availity, the nation’s largest real-time health information network, participated in a pilot initiative with America's Health Insurance Plans (AHIP) to identify solutions for providing real-time updates and validation of provider directories through a single workflow. See the results!

In a time of healthcare consumerism and high-deductible health plans, the patient has become a major revenue source for healthcare organizations. But without strong point-of-service patient collection strategies, providers could be seeing their payments walk right out the door with their patients.

With all the uncertainty, there’s one question that keeps surfacing—will risk adjustment go away if Congress repeals the Affordable Care Act (ACA)? The answer is no and here’s why – risk-based financial models extend far beyond those included in the ACA.

Health plans have long supplied their members with provider directories to assist in finding in-network physicians who are accepting new patients. But what should be a helpful aid often isn't, due to outdated or just plain wrong data. Not only is this frustrating for patients trying to find an available provider, it can cost them more than they anticipated if they end up incurring out-of-network fees for a physician they thought was in-network.

In this episode of Availity Access, Jeff Chester, Availity’s Chief Revenue Officer and Senior Vice President, discusses what he sees as the big healthcare trends in 2017.

 
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