Revenue Cycle Management
Availity Revenue Cycle Management goes beyond conventional claims clearinghouses and uses smart technology and an intuitive interface to help you receive payments faster while reducing the administrative burden on your office staff. With powerful reporting and intelligent analytics that pinpoint trends affecting your revenue cycle, you can dramatically reduce your accounts receivable and improve cash flow so you can operate a healthy business.
Whether you are a hospital, medical practice, health system, or billing service, Revenue Cycle Management can help standardize, streamline and automate tasks related to:
- Patient access
- Billing and collections
- Claim tracking and rework
- Payment posting
With the most dynamic feature set on the market, Availity Revenue Cycle Management can help your operations thrive at every stage of the revenue cycle.
Claims Submission Management
- Submit claims instantly in standard and non-HIPAA standard formats*, and reduce or eliminate paper claims.
- Submit claims in a batch or one-at-a-time, 24/7, to send to the health plan multiple times throughout a day.
- Get real-time notification of electronic receipts and line-item, detail-level tracking.
*Non-standard formats must support ICD-10 codes to qualify for conversion. Availity does not convert ICD-9 codes to ICD-10.
- Benefit from automatic eligibility and benefit checks on submitted claims, ensuring completeness and accuracy.
- Identify errors in real time, including HIPAA compliance, NPI and provider- and payer-specific errors.
- Quickly see the fields to be fixed, plain-language summaries of each error and recommended actions for correcting them.
- Use one standardized correction process for every payer, increasing efficiency for your staff.
- View error patterns and trends in on-demand reports.
Claims Delivery Management *
- Ensure your claims take the fastest path to the health plans with our network of direct connections.
- Send claims in a batch or one-at-a-time, 24/7, for submission to the health plan multiple times throughout a day.
- Submit claims in non-HIPAA standard formats* and have them automatically converted to the format preferred by the health plan and/or mandated by the government.
* Non-standard formats that currently support ICD-9 codes must support ICD-10 codes to qualify for conversion. Availity does not convert ICD-9 codes to ICD-10.
- Determine the status of pended claims with a daily automatic refresh.
- Use automated searches and sorts to pinpoint claims that need the most attention, including unpaid, delayed and pended claims.
- Search claim histories for proof of timely filing.
- Find highlighted patterns, problems or delays in full lifecycle displays of individual or batched claims.
- Automatically post ERAs in the format required by most practice management systems.
- Track remits easily with plain-language explanations.
- Consolidate machine- and human-readable remittances into one common file feed, reducing the number of files to auto-post.
Epic Electronic Health Record Integration
- View the claim status, correct clearinghouse and payer edits, and resubmit the claim from a work queue — all from within your Epic system.
- Run eligibility during claim processing and reduce errors—ultimately, lowering the number of denials and speeding your payments.
- Accelerate cash flow, enjoy greater financial stability and improve your workflow.
View compatible systems list*
Revenue Cycle Management works with any practice management or hospital information system that can generate HIPAA-standard formats, as well as many non-standard and vendor-specific proprietary formats*. Don’t see yours listed here? Contact us for more information.
*Non-standard formats that currently support ICD-9 codes must support ICD-10 codes to qualify for conversion. Availity does not convert ICD-9 codes to ICD-10.
ABELMed EHR – EMR / PM
Allscripts Professional PM
AMS Medical Management System
Brickell Medical Office
Clinic Management System
E Med Pro Omega
Electronic Billing Center (EBC)
Greenway Prime Suite
Hi-Tech Software Solutions
Imaging Center Information System (ICIS)
Medical Billing Solutions
Misys PM (+Medic)
Omni Medical Systems
Physician’s Office Manager
Physicians Practice Management
Point and Click
Practice Manager 2000
Practice Manager X3
Practice Point Manager
Urgent Care Works
Use these modules to achieve the highest level of performance for your business.
Advanced Claims Editing
Create custom edits that fit your organization’s business rules—without the need for highly technical and specialized resources.
- Create and control your own custom edits, including payer- and provider-based rules.
- Navigate a series of step-by-step screens for a user-friendly interface that cuts down on the need for programming resources.
- Reduce denials with customized, up-front, provider-specific error identification.
- Adapt to all unique provider- and payer-specific rules in any practice-management system environment.
- Cut down on vendor costs by using a single integrated, standardized workflow.
Benchmark your practice’s performance against state and national peers.
- Provide transparency into your business operations for even more visibility and control over your revenue cycle.
- Analyze, compare and monitor key business performance metrics for reimbursement, staff productivity, payer performance and code utilization.
- Customize the system per user level, so answers to questions are simple and intuitive.
See the detail behind your denial rates to address errors, reduce write-offs and improve your cash flow.
- Coordinate your denial management with any practice management or billing system.
- Quickly identify denial patterns and health plan payment delays.
- Automatically complete appeal forms for resubmission.
- Quickly access patient-specific explanations of benefits (EOBs), even without full information.
- Measure practice performance against your peers with benchmark reports.
EOB to ERA Conversion
Automated remittance and posting allows you to automatically post all of your payments, regardless of format.
- View all of your remittances in a standard format.
- Achieve consistency and accuracy in posting while you reduce costs of data entry and paper remittance handling.
- Eliminate errors — and rejections — to expedite payments and account reconciliation.
Patient Payments *
Make Availity Revenue Cycle Management your single source to manage patient payments—integrate claim status, payment, claim detail and history information into a single database.
- Give patients the option to pay online using a branded website.
- Process payments for co-pays at the point of service in real-time using a USB card reader or via keyboard entry.
- Integrate your payments directly into Availity Revenue Cycle Management, removing the need to use separate, standalone batch terminals.
*Not available for hospitals.
Use this service to integrate patient statements and pre-collection letter printing with the rest of your claims/payment process, providing the same transparency and common workflows.
- Submit patient statements and pre-collection letters monthly, weekly or even daily.
- Send patient statements as often as you like for next-day processing, in many cases.
- Choose from a variety of professional statement formats that comply with the Patient Friendly Billing® Project and can be printed on color paper stocks.
*Not available for hospitals.
Secondary Claim Management
Automate the generation and submission of secondary claims.
- Electronically submit fully compliant secondary claims to health plans.
- Automatically query participating Blue Cross and Blue Shield plans for the presence of crossover claims from Medicare.
- When a paper secondary claim is necessary for a single patient, we’ll print and mail an explanation of payment (EOP).
Self-pay Eligibility Verification
Optimize reimbursement by verifying Medicaid or healthcare coverage for self-paying patients. Many self-paying patients are not aware they are covered under Medicaid or major healthcare plans. This tool can help you:
- Capitalize on additional reimbursement opportunities by electronically matching self-pay patients against major health plans as well as Medicaid databases.
- Run one eligibility batch request automatically against five health plans consecutively.
- Track the number of total submitted requests across all health plans, along with the positive responses.
Availity offers a fully integrated paperless solution to Workers’ Compensation–with easy setup and deployment.
- Connect with 2,800 non-health care entities (payers/employers) that accept and process Workers’ Compensation claims.
- Submit cleaner Workers’ Compensation claims faster with state-specific, up-front editing.
- Improve the speed and accuracy of your Workers’ Compensation claims with HIPAA compliant editing for non-HIPAA transactions—all within your revenue cycle management workflow.
- Easily manage the processing, delivery, and tracking of the 275 attachment file for supporting documentation.
- Automated capabilities to attach documentation to claims through the PWK segment.
For practices and hospitals
View our Revenue Cycle Management payer list to make sure we’re connected to the health plans you work with.
Contact us to talk with a representative about how Revenue Cycle Management can improve the health of your business.
Contact us to talk with a representative about offering Revenue Cycle Management to your customers.
Featured Case Study
Asheville Anesthesia Associates
Asheville Anesthesia Associates faced a growing accounts receivable file and a payment collection process that was too slow. Find out how they used Availity Revenue Cycle Management to reduce time-to-payment by 75 percent, and reduce their average days in A/R by 62.5 percent.