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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 Nathan von Colditz has joined the company as Chief Strategy Officer (CSO). In his role, von Colditz is responsible for leading Availity's corporate strategic activities and positioning the organization for both long-term and short-term initiatives.

Availity, the nation’s largest real-time health information network, today announced a strategic alliance with PriorAuthNow, the leading real-time prior authorization network that connects providers and payers, to form the healthcare industry’s largest integrated prior authorization network.

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.

Fast Healthcare Interoperability Resources (FHIR) is helping to transform healthcare by enabling payers and providers to share information more effectively.

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.

Does it ever feel like the language around healthcare transactions is purposely confusing? Do you find yourself googling terms…and still not understanding what they mean? It’s not you. It’s us—the healthcare IT industry. We need to do a better job explaining our business processes in clear, simple language. Availity’s new EDI 101 series is our attempt to reduce confusion by explaining things as simply as possible.

Physicians Practice® spoke with Krisi Hutson, the product line director at Availity, to discuss some of the ways in which she has been seeing providers help their patients to avoid surprise billing scenarios.

In this installment, I check in with Lillian Phelps, senior director of product management at Availity to discuss claims management, the relationship between payors and providers, and how technology can help to streamline and automate these communication pathways in a way that benefits everybody.

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.

As the COVID-19 pandemic has gripped the world, many providers have adopted an all-hands-on-deck approach and mentality for treating COVID-19 patients, stretching their resources to the breaking point. We have heard about the frontline heroes who have sacrificed their own health and safety to treat patients and, in less-fortunate scenarios, comfort patients in their last moments as they were quarantined from loved ones. What has been less recognized is the work and sacrifice put forth by providers’ back-office staff. Many back-office workers have had to transform their operational practices after shifting to “work-from-home” mode to avoid potential exposure and minimize traffic to hospitals and physicians’ offices.

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.

Coverage identification tools help providers find active member coverage by sending multiple eligibility inquiries (270) to payer networks until they get a hit. But for many payers this increased traffic is affecting real-time network performance and causing time-out errors for providers who need to check eligibility at the point of service.

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.

While providers have many legitimate concerns about the PA process, it remains an important tool to help ensure that the care patients obtain is safe, effective, and necessary. Given the nature of the prior authorizations process, it’s inevitable this practice will lead to some level of provider abrasion; however, the healthcare industry is taking steps to reduce the burden prior authorizations create.

Availity, a locally headquartered health information network, announced it is partnering with Jacksonville University to set up a scholarship fund for nurse practitioners who could practice independently under a new state law. It also addresses Florida's shortage of primary care physicians. “Forty-eight percent of physicians in Florida are expected to retire in the next 10 years," according to the Florida Association of Nurse Practitioners. "Florida needs an estimated 3,000 to 5,000 primary care providers over the next five to 10 years. Medical schools cannot graduate enough physicians to meet the need."

Responding to a new law that will allow nurse practitioners to operate independent primary care practices, Jacksonville University is rolling out a program that will allow nurse practitioners to get needed credits for free. Scholarships for the program are funded by a $100,000 donation from Jacksonville-based Availity, a health care IT company that provides the technological infrastructure to connect providers and insurance companies.

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.

The COVID-19 pandemic has led payers and providers to embrace electronic encrypted documents and other technology — and that has fostered greater collaboration between them. As the U.S. healthcare system makes gradual and persistent strides towards value-based care, success within this new payment model depends on greater collaboration between payers and providers. Until recently the pace of this engagement has been slow. However, the COVID-19 pandemic has caused an acceleration in payer and provider collaboration.

Since the emergence of value-based care, the need for greater collaboration between healthcare’s traditional adversaries, payers and providers, has received lots of attention but results have sometimes been less tangible. Now, as a result of the COVID-19 pandemic, payer – provider collaboration has accelerated at an unprecedented rate within the health industry ecosystem.

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...

Because many of us are using the lull in our normal routines to brush up on skills or learn new ones, we thought this would be a good time to remind you that Availity features a wide range of online courses to help you get up to speed on our offerings. Whether you’re new to Availity and want a deep dive into the different workflows, or you’re a long-time user looking for specific productivity tips, our course catalog has something for everyone.

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...

Realizing the promise of value-based healthcare will require a level of payer and provider collaboration virtually unheard-of in the recent past—and health information management (HIM) professionals play an essential role in achieving this reality. To achieve success in the new value-based world, both payers and providers must work together to develop the most efficient means of sharing data, managing risk, validating provider credentials, processing claims, controlling costs, and optimizing the consumer experience. However, in the realm of provider data management (PDM), efforts directed towards payer-provider collaboration are expensive and time-consuming...

Beginning February 10, 2020, Anthem Blue Cross will begin using Availity’s medical attachment functionality to request and obtain medical records from providers during its post-payment claims review (audit) process. To utilize this functionality, providers must opt into the medical attachment functionality through the permissions in Availity’s enrollment center. Providers who have not opted in will continue to receive requests via paper...

Value-based healthcare demands meaningful payer-provider collaboration. However, burdensome administrative processes and inefficient solutions stunt the ability of payers and providers to share data, manage risk, validate credentials, process claims, control costs and optimize the consumer experience. These information bottlenecks are most acute in the area of provider data management (PDM).

Patients deserve access to the safest, most effective and highest-quality care. To achieve that goal, health insurance providers may use prior authorization – a systematic approach based on clinical evidence and data that ensures patients receive safe and effective treatments. Today, America’s Health Insurance Plans (AHIP), along with several of our member insurance providers, is launching the Fast Prior Authorization Technology Highway (Fast PATH) initiative to improve the prior authorization process...

As Product Line Manager, it’s my job to try different approaches for gathering better feedback from our users. That’s why, when I was first tasked with redesigning Availity’s Remittance Viewer tool, I started with a customer advisory board. This insider channel helped me elicit raw feedback from my target audience. Additionally, daily reports and in-person provider usability studies have helped increase my understanding of our users’ pain points. The result is a redesigned, shiny new Remittance Viewer Tool.

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.

We may never completely eliminate denials, but there are ways to proactively prevent them, particularly recurring denials caused by your claim workflow. From small practices to large Epic health systems, we see a surge in customers working to dramatically reduce error rates, improve cash flow, and reduce write-offs.

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.

Countless businesses and healthcare organizations miss out on their portion of available settlement proceeds each year. On average, only about 20% of eligible entities collect their share of any given settlement fund. In many cases, the proceeds represent a significant amount that is added right to your bottom line. While settlements vary, one constant is that a claim must be submitted in order to collect any money. This is where a Settlement Recovery Service can help.

In a recent webinar, we discussed the importance of patient satisfaction and how it can impact the revenue of your practice. Understanding patient satisfaction is valuable for providers who want their patients to keep coming back. Here’s how practitioners can keep retention high and ultimately grow their practice.

In a recent webinar TSYS coordinated with Availity, we discussed the importance of understanding today’s patients and their unique expectations. This understanding is measured by patient satisfaction, which gives providers valuable insights into the effectiveness of their care. Increasing patient satisfaction has become a major initiative for practitioners because it’s directly linked to patient retention. Here are the 5 components of improving patient satisfaction at your dental practice.

A key to patient engagement is keeping your clients as informed as possible about their options for treatment, medications, recovery, and all other aspects of the healthcare system. A practice that is fully engaged with their patients works more efficiently, from setting up follow-up visits to receiving electronic reminders about appointments, and this personalized engagement is now expected. Digital communication is not something you can disregard—patients want personalization and the ability to speak to their health practitioner on the platforms they us

IRVINE, Calif.--(BUSINESS WIRE)--Feb. 11, 2019-- For healthcare providers, the laborious process of registering patients, estimating costs, collecting up-front payments, reducing denials and securing overall financial clearance is challenging, requiring the immediate need for efficiency and improved workflow. As deductibles rise, patient demand for cost transparency prior to service is skyrocketing. To meet these needs, NextGen Healthcare, Inc. (NASDAQ:NXGN), the leading provider of ambulatory-only technology solutions, and Availity, the nation’s largest real-time health information network, have collaborated to offer clients NextGen® Pre-Service Solutions.

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.

medQ, Inc. and Availity announced an agreement to provide Availity Patient Access and AuthPal services through the Q/ris 3000 workflow suite of products. With this integration, Q/ris 3000 will quickly process physician orders, obtain prior authorizations, and verify insurance for all diagnostic imaging procedures. In addition, the Q/ris 3000 integrated app will also calculate how much patients will owe for that exam to ensure they are aware of their financial obligations prior to arrival for the procedure.

Consumers with health insurance, both independent and employer sponsored, rely on insurers’ provider directories to make choices about their plans and find physicians that are right for them. Directories include vital information such as essential contact details, distance from public transportation, accessibility for individuals with disabilities, languages spoken by practitioners and staff members, and more.

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.

The healthcare industry still has a big paper problem. According to one report, faxes account for almost 75 percent of all medical communication.

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.

Claim submissions are the most common electronic transactions in healthcare, edging out even eligibility and benefits checks, which are often still performed by phone. It’s clear that submitting claims electronically leads to faster payments and fewer denials, at less cost to providers and payers, however six percent of claims are still submitted via paper.

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.

Countless businesses and healthcare organizations miss out on their portion of available settlement proceeds each year. On average, only about 20% of eligible entities collect their share of any given settlement fund. In many cases, the proceeds represent a significant amount that is added right to your bottom line. While settlements vary, one constant is that a claim must be submitted in order to collect any money. This is where a Settlement Recovery Service can help.

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.

Data Dimensions, a leader in business process automation, and Availity, the nation’s largest real-time health information network, now offer the workers’ compensation market a new way to connect payers and providers by leveraging Availity’s Provider Engagement Portal as part of Data Dimensions’ Shared Services solution. This multi-payer platform serves as an entry point for providers who require secure access to their payers regarding clinical and administrative transactions.

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.

Prior authorizations may be as popular among providers as ants at a picnic, but they have become a common and necessary part of the reimbursement process. As a result, being able to manage prior authorizations efficiently is critical to maintaining a healthy revenue cycle and avoiding issues such as denied claims, administrative waste, excessive staff turnover and, of course, patient dissatisfaction.

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.

Join us Friday, 11/10 at 1pm ET for our tweetchat, Confidence Through Compliance, featuring our favorite HIPAA lawyer, Matt Fisher (@Matt_R_Fisher), and our Availity compliance guru, Erika Ables (@Erika_Ethics), as we discuss how compliance can enhance everything in healthcare from cybersecurity to patient interactions.

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.

Join us Friday, 10/13 at 1pm ET for our tweetchat, Healthcare Credentialing: The Good, the Bad, and the Scary, featuring Michelle Barry, our expert of health plan provider data management, Don Lee, president of Glide Health IT, and Shahid Shah, The Healthcare IT Guy, as we discuss what processes and tech can remove the dread that looms around healthcare credentialing.

The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) was passed to make healthcare delivery more efficient and to protect the privacy of patients. In general, HIPAA does not distinguish between physical and mental health in protecting patient privacy. While some advocates argue that not distinguishing between physical and mental health is the only way to protect the privacy of those with mental illnesses, others, including many families with loved ones suffering from mental illness, argue that excluding family members from mental health records can have a devastating effect on the patient, the family, and the public.

As you are likely aware by now, CMS’ final rule on Emergency Preparedness Requirements for Medicare and Medicaid Providers and Suppliers went into effect on November 15, 2016 and will be implemented on November 15, 2017. This final rule establishes national emergency preparedness requirements for Medicare and Medicaid participating providers and suppliers to plan adequately for both natural and man-made disasters and coordinate with federal, state, tribal, regional, and local emergency preparedness systems.

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.

Join us Friday, 9/8 at 1pm ET for our tweetchat, Big Data - Present, Future, and Best Practices, featuring Availity Director of Data Management and Analytics, Jeff Currier (@_jcurrier_), as we discuss how healthcare can and IS using Big Data to improve everything from costs to patient experience.

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.

Join us Friday, 8/11 at 1pm ET for our tweetchat, Patient as the New Payer – Patient Payments, featuring TSYS’s Director of Relationship Management, Ben Buchanan (@benbuchanan28), and our own Principal of Payment Solutions, Sean Kilpatrick (@spkilpatrick), as we discuss the why and how of assessing, capturing, and collecting patient payments in our new healthcare world.

Payers and providers have for decades stayed in their silos, leading to a more fractured and adversarial healthcare system. That relationship, however, is starting to soften for many in the industry. Payer-provider partnerships put the two groups on the same team in hopes of reducing costs and improving care and outcomes through sharing data and better communication.

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.

Join us Friday, 7/14 at 1pm ET for our tweetchat, The (Continued) Case for Interoperability, featuring our own Platform Solutions Architect, David Quickstad (@DQuickstad), and the CTO of HL7, Wayne Kubick (@WayneKubick), as we discuss how interoperability has become increasingly important in healthcare.

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.

Online and multi-payer portals are viewed as promising solutions to improve communications between payers and providers while also mitigating costs, yet these tools are underutilized. While 60 percent of payers prefer the use of online portals as the primary means of communication with providers, it seems providers are less enthusiastic, as only 39 percent of practice-based providers and 40 percent of facility-based providers strongly support online portals as a primary source, according to a survey by Availity.

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.

Is your revenue at risk? If your hospital or practice isn’t fully adhering to the risk adjustment and Hierarchical Condition Category (HCC) coding requirements for Medicare Advantage (and some Medicaid) plans, the answer may be yes. Many healthcare organizations underestimate what’s required for these plans and it’s costing them money.

A recent report by CAQH demonstrated that outdated, time-consuming manual processes are still being utilized to exchange information between insurers and providers, particularly financial and administrative data, and it costs us all a fortune. What can we do about this waste? CAQH CORE is a non-profit that brings entities across the healthcare industry together to encourage automation by promoting a common set of rules and underlying standards governing electronic data exchange. To highlight which entities are meeting – or exceeding – these rules and standards, CAQH CORE has developed a certification program.

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.

Any successful company recognizes the importance of customer touchpoints—those critical moments when a customer engages with someone in the organization. “With the rise of consumerism, healthcare organizations are no different,” says Sarah Holt, a nationally known author and healthcare management consultant. Holt believes that for too long hospitals and physician practices haven’t focused enough on business operations, assuming clinical expertise would make up for any shortcomings.

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!

For health insurance companies, an accurate, easy-to-update standardized database for network provider data is the Holy Grail. Along with being a major source of frustration for members, inaccurate provider information negatively impacts claims processing, provider credentialing and the ability to ensure compliance with network adequacy rules. It also can create obstacles for providers that want to create a value-based benefit approach.

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.

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.

Nationwide, just over six percent of healthcare claims are submitted using paper forms. That number has remained steady over the past few years, even though research has shown conclusively that providers can save more than 50 percent on administrative costs by submitting claims electronically.

 
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