KLAS Research Recognizes Availity for Innovation in Authorization Determination
5.22.2023 By Availity
Availity, the nation’s largest real-time health information network, was named a co-recipient of the KLAS Payer/Provider Points of Light Award, in collaboration with Blue Cross Blue and Blue Shield of Minnesota, Itiliti Health, and Mayo Clinic to introduce efficiencies and automation in authorization determination.
“We are proud to be recognized for our collaboration with our Blue Cross and Blue Shield of Minnesota, Itiliti Health, and Mayo Clinic,” said Russ Thomas, CEO of Availity. “Our combined efforts enable providers to know instantly if an authorization is required, eliminating the need to utilize the call center and other manual processes.”
The KLAS Points of Light Award celebrates success stories from payers, providers and healthcare technology companies that work collaboratively to solve administrative and clinical challenges. The collaborators delivered a presentation on their authorization determination work at the 2023 K2 Summit, this month, in Salt Lake City.
The goal of this collaboration was to eliminate—or significantly diminish—abrasion points in the authorization process, particularly when determining if an authorization is required for a care service.
According to Blue Cross and Blue Shield of Minnesota, nearly 40% of providers’ calls into the health plan’s call center related to whether an authorization was needed. The health plan estimated that the resources required for each call to handle each request cost between $5 and $7, and up to $13 to $15 for requests via fax.
To create a more automated, self-service solution for providers to quickly establish if an authorization was required, the health plan utilized Availity’s authorization determination app—Is Auth Required—available through the Availity Essentials multi-payer provider platform. The app linked to Itiliti Health’s PA Checkpoint app, which is used by Blue Cross and Blue Shield of Minnesota to create and manage a database of the health plan’s authorizations rules.
“We’re proud of the results this collaboration has produced for the health plan,” said Michael Lunzer, CEO and Co-Founder of Itiliti Health. “This KLAS recognition demonstrates the ability for technology developers, payers and providers to come together to solve costly and manually driven administrative burdens.”
Together, these apps allowed the health plan’s provider network, which includes the Mayo Clinic, to check if an authorization was required before initiating a request. Providers receive real-time approval messages within their existing workflow. If an authorization is required and pends for review, a provider can electronically attach the required medical record.
“This collaboration made it easy and intuitive for providers and our service team to use a self-service tool to get the information they need quickly,” said Rhendy Tullis, Senior Business implementation Lead for Blue Cross and Blue Shield of Minnesota. “We have seen significant provider utilization of the tool, a reduction in calls, appeals, and instances where auths were requested but not needed.”
According to the KLAS case study, Blue Cross and Blue Shield of Minnesota realized several benefits of this collaboration, including:
- $3.9 Million in estimated savings over three years across the health plan’s entire provider network.
- Increased portal use to 70% and eliminating the faxing option for local providers.
- Call volume for authorization requests dropped to 50 a month from 200 a month after tool was implemented.
- The Availity app is utilized about 100,000 times a month across the health plan’s provider network.
- In a recent provider survey, 77% of respondents indicated they found the look up tool very or extremely helpful.
Availity is the place where healthcare finds the answers needed to shift focus back to patient care. We work to solve communication challenges in healthcare by creating a richer, more transparent exchange of information among health plans, providers, and technology partners. As one of the nation's largest health information networks, Availity facilitates billions of clinical, administrative, and financial transactions annually. Our suite of dynamic products, built on a powerful, intelligent platform, enables real-time collaboration for success in a competitive, value-based care environment.
For more information, including an online demonstration, please visit www.availity.com or call 1.800.AVAILITY (282.4548). Follow us on LinkedIn and Twitter.
KLAS is a data-driven company on a mission to improve the world’s healthcare by enabling provider and payer voices to be heard and counted. Working with thousands of healthcare professionals, KLAS collects insights on software, services, and medical equipment to deliver reports, trending data, and statistical overviews. KLAS data is accurate, honest, and impartial. The research directly reflects the voice of healthcare professionals and acts as a catalyst for improving vendor performance. Learn more at KLASresearch.com.