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.

Edit/Error Management

  • 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.

Status Management

  • 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.

Remittance Management

  • 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.

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.

6N Essentials

ABELMed EHR – EMR / PM

Abraxas PM

AccuMed

Ac-Cura

AdvancedMD

Advantx

Agastha

AllMeds

Allscripts Professional PM

Alta Point

AMS

AMS Medical Management System

American HealthTech

Amicas

AR-Express

Aprima

AS/PC

Autumn8

Avatar PM

Bradford Scott

Brickell Medical Office

CareRevolution

CareVoyant

CATT EHR

CBSI

Centricity

Chiro8000

ChiroSuite

ChiroTouch

CiverPsych

Clinic Pro

Clinic Management System

CMHC

CNS

CoAction

COMET

Companion

Compulink

Concept

Crystal PM

CureMD

DataMedic

DentalWriter

E Med Pro Omega

e-MDs

eClinicalWorks

Eclipse

Electronic Billing Center (EBC)

Empower

EnableDoc Billing

Encounter Manager

EncounterWorks

Epic

EThomas

Evolve

Experior

EZ Biz

EZ Cap

EZClaim

FlexMedical

Future Health

GEMMS ONE

gloPM

Greenway Prime Suite

HealthPAC

HealthPort

HealthPro

HealthPro8000

HealthMEDX

HealthSpan

Hi-Tech Software Solutions

Homecare Management

HomeWorks

Ideal

IDX/Flowcast

IDX/Groupcast

Imagine

Imaging Center Information System (ICIS)

iMedics

Inception

Incisive MD

InfoSys

Innovation

InteGreat PM

Integrity

Intelligent Medical

Intergy

JefBar

Kredo

LSS

Lytec

MacPractice

Magview

MARS

MaximEyes

MD Navigator

MDIV

MDsuite

MED/FM

MedAct

medAnywhere

MedBill

Medic Elite

Medical Billing Solutions

Medical Manager

Medical Mastermind

Medicrus

MedInformatix

MediNotes Clinician

Mediserv

Medisoft

Medisoft (DOS)

Meditech

MEDfx

MedLook

MedOffice

MedSuite

MEDVantage

Medware

MedWorxs

Mestamed

MICA Systems

MicroMD

MIMS

Misys Tiger

Misys PM (+Medic)

Misys Vision

MOSAIQ

MS Health

MyWay

NetPractice

NextGen

Nextech

Noble*Direct

Northern

OfficeMD

Office Mate

Office Practicum

Omni Medical Systems

Orchid

Ortivus

PacWare

PCIS Gold

PeakPractice

Perfect Care

PhyGeneSys

PhyMD

Physician’s Office Manager

Physicians Practice Management

Platinum Systems

PMA

Point and Click

PowerWorks

PPM

Practice Express

Practice Manager 2000

Practice Manager X3

Practice Partner

Practice Point Manager

Practice Resource

Practice Revolution

PracticeStudio

PracticeSuite

PRISM

ProFit

ProVision

psychconsult Provider

PTOS

Pulse PRM

PyraMED

QA Solutions

QS/1

QuadraMed

Quixote

Rabbit

Radysans

Raintree

RescueNet Billing

Seacoast

Signature

SilkOne

SOAPware

SoftAID

SOS

SuiteMed IMS

Suncoast

Sunrise

Supra

SydaMed

SYSTOC

TexTALK MD

TheraManager

TheraOffice

therapist helper

TherapistPro

TherAssist

Tops Suite

TotalMD

TPS2000

Turbo

Urgent Care Works

VersaForm

VersaSuite

Visionary

Vitalworks

WinPMI

Workflow

Xperical

6N Essentials

ABELMed EHR – EMR / PM

Abraxas PM

AccuMed

Ac-Cura

AdvancedMD

Advantx

Agastha

AllMeds

Allscripts Professional PM

Alta Point

AMS

AMS Medical Management System

American HealthTech

Amicas

AR-Express

Aprima

AS/PC

Autumn8

Avatar PM

Bradford Scott

Brickell Medical Office

CareRevolution

CareVoyant

CATT EHR

CBSI

Centricity

Chiro8000

ChiroSuite

ChiroTouch

CiverPsych

Clinic Pro

Clinic Management System

CMHC

CNS

CoAction

COMET

Companion

Compulink

Concept

Crystal PM

CureMD

DataMedic

DentalWriter

E Med Pro Omega

e-MDs

eClinicalWorks

Eclipse

Electronic Billing Center (EBC)

Empower

EnableDoc Billing

Encounter Manager

EncounterWorks

Epic

EThomas

Evolve

Experior

EZ Biz

EZ Cap

EZClaim

FlexMedical

Future Health

GEMMS ONE

gloPM

Greenway Prime Suite

HealthPAC

HealthPort

HealthPro

HealthPro8000

HealthMEDX

HealthSpan

Hi-Tech Software Solutions

Homecare Management

HomeWorks

Ideal

IDX/Flowcast

IDX/Groupcast

Imagine

Imaging Center Information System (ICIS)

iMedics

Inception

Incisive MD

InfoSys

Innovation

InteGreat PM

Integrity

Intelligent Medical

Intergy

JefBar

Kredo

LSS

Lytec

MacPractice

Magview

MARS

MaximEyes

MD Navigator

MDIV

MDsuite

MED/FM

MedAct

medAnywhere

MedBill

Medic Elite

Medical Billing Solutions

Medical Manager

Medical Mastermind

Medicrus

MedInformatix

MediNotes Clinician

Mediserv

Medisoft

Medisoft (DOS)

Meditech

MEDfx

MedLook

MedOffice

MedSuite

MEDVantage

Medware

MedWorxs

Mestamed

MICA Systems

MicroMD

MIMS

Misys Tiger

Misys PM (+Medic)

Misys Vision

MOSAIQ

MS Health

MyWay

NetPractice

NextGen

Nextech

Noble*Direct

Northern

OfficeMD

Office Mate

Office Practicum

Omni Medical Systems

Orchid

Ortivus

PacWare

PCIS Gold

PeakPractice

Perfect Care

PhyGeneSys

PhyMD

Physician’s Office Manager

Physicians Practice Management

Platinum Systems

PMA

Point and Click

PowerWorks

PPM

Practice Express

Practice Manager 2000

Practice Manager X3

Practice Partner

Practice Point Manager

Practice Resource

Practice Revolution

PracticeStudio

PracticeSuite

PRISM

ProFit

ProVision

psychconsult Provider

PTOS

Pulse PRM

PyraMED

QA Solutions

QS/1

QuadraMed

Quixote

Rabbit

Radysans

Raintree

RescueNet Billing

Seacoast

Signature

SilkOne

SOAPware

SoftAID

SOS

SuiteMed IMS

Suncoast

Sunrise

Supra

SydaMed

SYSTOC

TexTALK MD

TheraManager

TheraOffice

therapist helper

TherapistPro

TherAssist

Tops Suite

TotalMD

TPS2000

Turbo

Urgent Care Works

VersaForm

VersaSuite

Visionary

Vitalworks

WinPMI

Workflow

Xperical

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.

Comparative Analytics

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.

Denial Management

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.

Patient Statements*

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).

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.

For vendors

Contact us to talk with a representative about offering Revenue Cycle Management to your customers.