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AAHAM – Summer Session. Agenda. Availity Overview Administrative Solutions Financial Solutions Clinical Solutions Summary. Availity Overview. The Availity Perspective.

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Presentation Transcript

Agenda
Agenda

Availity Overview

Administrative Solutions

Financial Solutions

Clinical Solutions

Summary



The availity perspective
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


Who is availity
Who is Availity?

More than 700 million annual transactions

$

>150

Direct Payers

>1,150

Indirect Payers

>65,000

Physician Offices

Availity®

Health Information Network

Business Solutions

Clinical Solutions

>400

Vendor Partners

- Clearinghouses

- Practice Management

Systems

- Hospital Information

Systems (HIS)

- Electronic Medical

Record (EMR) Systems

>1,000

Hospitals

>455,000

Employers

>70,000,000

Members


Where does availity do business
Where Does Availity do Business?

Central Region

(OH, KY, IN, MO, WI)

Live in January 2010

WA

ME

ND

MT

MN

VT

NH

OR

Northeast Region

(CT, ME, NH)

Q2 2011

NY

WI

MA

SD

ID

CT

RI

MI

WY

NJ

PA

IA

OH

NE

DE

MD

New York

Q3/Q4 2011

IN

NV

IL

WV

VA

UT

CO

CA

MO

KS

KY

CA

Virginia

Live in May 2010

NC

TN

OK

SC

AR

AZ

Georgia

January 2011

NM

GA

AL

MS

West Region

(CA, CO, NV)

November 2010

LA

TX

FL

  • Availity Deployed

  • States with Availity Activity

  • 2011 WellPoint States

AK

HI



Improving outcomes reducing costs
Improving Outcomes & Reducing Costs

Administrative

  • Supporting National HIT Objectives

  • Security & Privacy

  • Compliance – HIPAA, CORE, EHNAC

  • Interoperability – seamless integration with multiple systems and stakeholders

  • Meaningful Use – leverage widely available, consistent administrative data

  • Deliver Quality – real-time access to actionable, relevant patient information at the point of care

  • Eliminate Cost – identify fraud through medication history access; save time by improving access to important information

  • Improve Outcomes – reduce avoidable adverse drug events by providing alerts at the point of care

  • Eligibility & Benefits, Claim Status, Claims, Referrals & Authorizations

  • Card Swipe

Financial

  • Patient Responsibility Estimation

  • Payment Collection

Clinical

  • Health Record Information

  • Electronic Prescribing


Health plan transactions
Health Plan Transactions

HIPAA compliant transactions with multiple health plans

Eligibility and Benefits

Authorizations and Referrals

Claims

Claim Status

Electronic Remittance

Web and integrated connections

Information is shared in real-time

Edits ensure data accuracy

Helps improve accounts receivable

Offered to providers at no charge

Available nationwide


File transmission options
File Transmission Options

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.

Direct Integration



Carecost estimator sm
CareCost EstimatorSM

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


Carecost estimator sm benefits
CareCost EstimatorSM Benefits

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


Carecollect
CareCollect®

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


Careprofile
CareProfile

  • Electronic Health Profile that draws information from claims submitted to multiple health plans.

    • Availity CareProfile provides an up-to-the minute, consolidated view of patients’ health care history across multiple providers.

CareProfile®

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.


CarePrescribe®

Value-Add Services

  • Electronic Prescribing Solution

    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.

Rx

CarePrescribe®

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.


Future administrative services
Future Administrative Services*

Claim Attachments

Support solicited delivery of claim electronic attachments

Reporting Enhancements

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

realmed

*Priorities and timelines may change.



Availity value

Workflow simplification and cost savings

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 compliance

Availity Value



Contact
Contact

P.O. Box 550857

Jacksonville, FL 32255-0857

904.470.4900

Bill Thomas

Channel Partner Sales Executive

904-470-4067

[email protected]

1.800.AVAILITY (282.4548)

www.availity.com


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