AAHAM – Summer Session. Agenda. Availity Overview Administrative Solutions Financial Solutions Clinical Solutions Summary. Availity Overview. The Availity Perspective.
It is Availity's mission to optimize information exchange between multiple health care stakeholders through a single, secure network.
Our goals are your goals:
Reduce administrative costs
Improve relationships between payers, providers, employers, patients
Use technology to improve workflow
Improve the quality, safety, and affordability of health care
More than 700 million annual transactions
Health Information Network
- Practice Management
- Hospital Information
- Electronic Medical
Record (EMR) Systems
(OH, KY, IN, MO, WI)
Live in January 2010
(CT, ME, NH)
Live in May 2010
(CA, CO, NV)
HIPAA compliant transactions with multiple health plans
Eligibility and Benefits
Authorizations and Referrals
Web and integrated connections
Information is shared in real-time
Edits ensure data accuracy
Helps improve accounts receivable
Offered to providers at no charge
Log on to the Availity portal to submit batch files and review, retrieve, download, and import response files and reports.
Availity Secure Web Portal
Exchange batch files without logging in to the Availity portal.
Secure File Transfer Protocol (SFTP)
Conduct transactions through your existing system in batch or real-time.
Helps determine a patient’s financial responsibility at the point of care
Based on member benefits, deductibles, provider contractual allowances, and benefit maximum accumulators at the time of inquiry
Collect the patient’s responsibility at the time of treatment, reducing accounts receivable
Offered to providers at no charge
CareCalc® is BCBSF’s branded product
Enables providers to collect the patient’s responsibility at the time of treatment, improving accounts receivable
CareCost Estimator is available when providers need it
Prior to the service as an estimate of patient responsibility
At the point of service when the patient checks out
When a patient contacts their provider to question a bill
Responses are provided real-time, based on information at the time of the inquiry
Process credit and debit transactions
Turn paper checks into electronic transactions
Set up recurring payments for repeat patients or installment payment plans
Void and credit payments
Perform end-of-day settlements
Run customized reports
Can replace existing point of sale device
Still relying on handwritten forms to get medical histories? Aside from the time it eats up, this process can leave out important clinical information. CareProfile is an electronic health record that draws information from claims submitted to multiple health plans. You get an up-top-the-minute, consolidated view of a patient’s care across providers, including diagnoses, prescriptions, and lab tests. You can improve patient safety and relationships and avoid duplicate services.
Availity CarePrescribe is an e-prescribing solution that provides real-time access to medication history, eligibility, and formulary information via a handheld device or the Availity portal.
Using a convenient handheld device or secure web site on Availity’s network, you can quickly and easily submit prescriptions electronically. You can even view therapeutic equivalents, drug interactions, and lower cost alternatives.
Support solicited delivery of claim electronic attachments
Enhance ad-hoc reports
Availity Remit Manager
Retrieve and present ERA data online in a standardized, human-readable format
Search, view and drill down to a claim service level
Access up to seven years of historical claims information
Revenue Cycle Management
*Priorities and timelines may change.
Administrative, clinical, and financial services available at no charge
Single secure connection with multiple health care constituents
Practice Management System (PMS) and Hospital Information System (HIS) integration in both real-time and batch
Improved information accuracy
Faster claims submission
Improved patient satisfaction
HIPAA/standards complianceAvaility Value