Jacksonville, Fla., March 29, 2016 – Florida health insurers are going live with a provider directory workflow solution from Availity, the nation's largest real-time health information network, to increase provider data transparency and enhance collaboration with their provider networks.
Availity and its health plan partners are engaged in a pilot initiative from America's Health Insurance Plans (AHIP) to identify solutions for providing real-time updates and validation of provider directories. Phase I of the project will include AvMed, Cigna, Wellcare, Florida Blue, and Humana, according to a press release issued by AHIP on March 22. This initiative may impact more than 20,000 practices and provider organizations in Florida, representing more than 100,000 practitioners.
This pilot is about a new level of coordination between health plans and providers, addressing the need for consumers to have more accurate, timely information about provider networks," said Russ Thomas, CEO of Availity.
Today, many health plans receive infrequent updates from their provider networks. Inaccurate information can cause problems for patients seeking the appropriate physician—only to be surprised by unexpected bills for out-of-network service or discover that the provider they have been sent to has moved, retired, changed affiliation, or isn't accepting new patients.
Availity's solution creates a profile of every physician in the company's network of more than 900,000 active providers, and alerts providers to "check and correct" their information in a provider's existing workflow when Availity identifies anomalies. Using a simplified user interface, providers can easily validate their profile or make critical updates, such as new office locations, office hours, physicians, and care specialties.
"Availity's solution will enable Florida Blue to update and validate our directory in real-time without disrupting the workflows of our provider partners," said Dianne Wagner, Senior Director of Provider Network Operations for Florida Blue. "This solution will also improve our efforts to enhance the customer experience and manage the health of our members."
According to Thomas, Availity's objective is to create a platform for new levels of health plan and provider collaboration.
Availity's provider directory validation workflow is part of its Provider Data Management solution, which allows providers to update their critical business information while performing claims-related tasks, keeping revenue flowing and reducing administrative burdens on both health plans and providers.
"Health plans are spending millions of dollars to generate analytics on members who are high risk or high cost. Health plans want to be able to synthesize this member data and share it with providers to help patients avoid costly catastrophic health events, which requires accurate provider data," Thomas said. "What makes Availity's PDM solution different is that we are not using other-sourced information, like information drawn from electronic health records or data purchased from third-parties. We are getting our information directly from our providers, validating it against our trusted provider directory, and confirming it through a closed loop interaction in the workflow."
As an industry-leading, HITRUST-certified health care information technology company, Availity serves an extensive network of health plans, providers, and technology partners nationwide through a suite of dynamic products built on a powerful, intelligent platform. Availity integrates and manages the clinical, administrative, and financial data needed to fuel real-time coordination between providers, health plans, and patients in a growing value-based care environment. Facilitating over 7 million transactions daily, Availity's ability to provide accurate, timely, and relevant information is vital to the financial success of its clients.
For more information, including an online demonstration, please visit www.availity.com or call 1.800.AVAILITY (282.4548).