Improve collaboration with your providers
If you’re reconsidering maintaining an in-house provider portal, Availity’s Provider Engagement Portal offers a multi-payer alternative that can improve communication between your health plan and your provider network. The Availity Portal features an intuitive interface and supports multiple workflows, reducing calls into your call center and ensuring providers have the information needed to serve your members.
Provider Engagement Portal Capabilities
Providers need the most up-to-date payer information available, especially at the point of care. With the patient management workflow, they can run eligibility and benefits transactions and receive care reminders when a member has an outstanding service.
Using the claims management workflow, providers can submit a claim, correct a submitted claim, and check a claim status. Health plans also have the option to implement the claims overpayment and claims appeal capabilities, which simplify and streamline these processes.
You can easily deliver the Electronic Remittance Advice (ERA) or 835 data to providers through the Availity Portal’s remittance viewer tool. Providers can research claims and payments, and because the data is in a human-readable format, rather than ANSI code, it’s easy for non-technical people to understand.
Provider Information Management
Keeping provider information current is a challenge, but Availity’s Provider Data Management (PDM) is designed to help you do just that by letting providers update demographic information through the Availity Portal. Learn more.
The Availity Portal offers multiple ways for you to share information with your provider network, including two-way messaging, home page notifications, and news and announcements.
Authorization and Referral Management
The Availity Portal helps you streamline the authorization process by giving providers a central location where they can check if an authorization is needed, submit the authorization with required documentation, and manage it all through a user-friendly dashboard.
While the Availity Portal is multi-payer tool, health plans still need a place to host proprietary, plan-specific information or tools. Payer Spaces gives you a secure location—branded with your organization’s logo—where providers can access this information.
Availity 360 uses administrative data, transactional data and other Portal activity to give you a clear picture of the network’s health. With Availity 360, you can identify trends and drill down into performance metrics based on payer, transaction type, and more.
Provider Engagement Portal + Clinical Gateway capabilities
Medical Record Exchange
Both health plans and providers want to stop sending faxes and mailing letters. The cost is enormous, the administration is cumbersome and frustrating, and there’s no quality standard or consistent format. That’s why providers use our Provider Engagement Portal to send clinical information and medical records, track and respond to requests over time, filter and sort their records, and manage to due dates.
Primary Care Physician Notification
Health plans need to communicate with providers when they receive notifications of admission. Our Primary Care Physician Notification alerts providers of a hospital admission via the Portal, and sends clinical messages through the Portal’s Clinical Viewer. This means the provider can be more accountable for the member’s care, can follow up after discharge, reconcile medications, reduce costs, and improve outcomes.
Clinical Quality Validation
Meeting quality measures requires clear and efficient communication between the health plan and the provider. With Clinical Quality Validation, a health plan can use the Portal to notify the provider about a member’s open quality gaps. The provider can then view the clinical information needed, submit the required documentation, and close the gap.
Clinical Gateway + Intelligent Gateway + Provider Engagement Portal capabilities
AutoAuth Create & Exchange
Availity uses ADT information to automatically create the authorization request (x 12 278) and send it to the health plan. Information is then relayed through a bi-directional EMR integration (HL7 with options for exchanging HL7 C-CDA and payer-based health records) to the care provider, often at the time of care.