Compliance at Availity
Availity’s Compliance Mission is to promote an organizational culture that encourages ethical conduct and a commitment to compliance with the law. Compliance is a core competency. Strengthening it not only reinforces our mission and our values, but also provides us with a competitive advantage in the marketplace.
Our comprehensive Ethics and Compliance Program is consistent with controls set by the Centers for Medicare and Medicaid Services (CMS), Electronic Healthcare Network Accreditation Commission (EHNAC), the Health Information Trust Alliance (HITRUST), as well as additional modifications to fit our unique environment.
Availity’s Senior Vice President of Legal and Regulatory Affairs serves as the company’s Chief Compliance Officer and Privacy Officer and is responsible for Compliance Program management and oversight.
Code of Conduct and Ethics
Availity has a long-standing and deep commitment to conducting business ethically, with integrity and in compliance with the law. Availity employees, and how they conduct themselves each and every day, are the key to Availity’s business success. This is why we make it a priority to educate our management, employees, and contractors on our high ethical standards through training, communications and the promotion of dialogue in ethical dilemmas.
Supplier Code of Conduct
The ethical business practices of Suppliers is essential to providing the best possible service to our customers. Our Supplier Code of Conduct sets forth Availity’s expectations of Suppliers as well as their personnel, agents, and subcontractors. All Availity Suppliers are required to hold themselves to the same high ethical standards that Availity promotes.
Our Compliance Program
Availity’s Compliance Program is structured in accordance with the Seven (7) Elements of an Effective Compliance Program as proscribed by the Federal Sentencing Guidelines issued by the United States Sentencing Commission and the Health and Human Services (HHS) division of the Office of the Inspector General (OIG). The following Programs are maintained as part of Availity’s Compliance Program: HIPAA Privacy Program, Anti-Bribery and Anti-Corruption (ABAC/FCPA) Compliance Program, and the General Data Protection Program.
The seven (7) elements of an effective compliance program are:
Knowing the Risks
Healthcare statutes, rules, regulations and obligations can be extremely complex and ambiguous at times and penalties for non-compliance can be quite severe. At Availity, we recognize the importance of taking preventative measures to minimize the risk of a violation. Availity is continually assessing risk within the organization by conducting various privacy and security assessments both annually and on a rolling basis. We have pushed risk assessment deep into the organization and these assessments help to identify risk concerns throughout the year. In addition, Availity follows requirements and standards established by CMS, EHNAC, and HITRUST for risks associated with our industry, which include, but are not limited to HIPAA Privacy and Security.
Transparency in Coverage
The Transparency in Coverage Final Rules require certain group health plans to disclose information regarding in-network provider rates and historical out-of-network allowed amounts and billed charges for covered items and services in two separate machine-readable files (MRFs). The MRFs for the benefit package options under Availity, L.L.C. Health and Welfare Plan are linked Here.
Helpful Links and Materials
A Summary of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Protected Health Information (PHI) is individually identifiable health information that is held or transmitted by a covered entity or business associate in any form or media (electronic, paper or oral). Below are the 18 identifiers of PHI:
At Availity, we believe that knowing when and how to report ethical issues is just as important as being educated on our ethical standards. The Compliance Program is designed to facilitate open dialogue with anyone who wishes to report an issue or concern. The Compliance Team maintains open lines of communication and encourages anyone with any ethical or compliance concern regarding Availity to reach out as soon as the concern arises.
To report any compliance or ethical concerns about Availity, its employees or its vendor partners please use the following methods:
- Call our anonymous 24/7 Compliance Helpline at 1-844-606-1753 (Domestic) / 000-800-100-1708 (India) or visit https://availity.ethicspoint.com.
- Email privacy concerns to PrivacyOffice@Availity.com
- You may also send correspondence to the following:
Availity Chief Compliance Officer
5555 Gate Parkway
Jacksonville, FL 32256