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The Availity Essentials Pro Advantage


In the rapidly evolving landscape of healthcare, providers face increasingly complex challenges in managing their revenue cycles. The key to navigating this intricate environment is leveraging advanced technological solutions that streamline processes, enhance efficiency, and optimize financial outcomes.

Availity Essentials Pro, our premier end-to-end revenue cycle solution, stands at the forefront of this transformation, offering an array of tools and features designed to meet the diverse needs of hospitals and physician practices.

Availity is the destination where providers connect with their payers to get the answers they need to focus on patient care. Availity simplifies how payers and providers exchange information, from the first check of a patient’s eligibility through final resolution of reimbursement.

Comprehensive Revenue Cycle Management

Availity Essentials Pro serves more 2 million providers from hospitals, health systems, and group practices, emphasizing our adaptability across various healthcare settings. This solution is tailored for proactive organizations dedicated to maximizing their revenue for services rendered. In an industry where every penny counts, Availity Essentials Pro emerges as a strategic ally for healthcare providers.

Addressing Customer Pain Points with Precision

Availity Essentials Pro meticulously addresses critical pain points in the healthcare revenue cycle:

  • Pre-service Denial Management: The platform provides enhanced data to frontline staff, mitigating downstream data issues and denials. This proactive approach ensures a smoother, more accurate pre-service experience.
  • Post-service Claims Management: Availity Essentials Pro equips providers with robust tools to manage their revenue cycle effectively. This includes reducing errors, consolidating processes, and driving process improvements.
  • Vendor Complexity and Integration: The solution addresses the challenge of working with multiple, non-integrated vendors by offering a unified platform that streamlines vendor interactions and data flow.
  • Expanded Solutions for RCM Power Users: Going beyond traditional RCM tools, Availity Essentials Pro offers advanced claim edits, denial prevention strategies, and comprehensive remittance solutions.

Enhancing Pre-Service Data Quality and Claims Management

The platform delivers critical payer and patient data, reducing manual processes and increasing claim quality. Key features include:

  • Eligibility and Benefits Verification: Real-time checks of eligibility, co-pays, deductibles, and coinsurance.
  • Patient Engagement Tools: A branded online statement and payment platform enhance patient communication and financial interactions.
  • Self-Pay Eligibility Verification: Identification of potential coverage options under Medicaid and major health plans.
  • Claims Submission and Error Management: Standard and non-HIPAA format submissions with real-time notification, detailed tracking, and an intuitive error management system.
  • Post-service claims management is fortified with tools that prevent errors, boost staff productivity, and offer insightful analytics:
  • Claims Submission: Capabilities for submitting individual or batch claims with real-time tracking and notifications.
  • Denial Prevention and Management: Tools for addressing the root causes of denials, including front-end claims editing and customizable payer-specific edits, supported by integrated appeals workflows.

Robust Analytics and Reporting for Informed Decision-Making

The platform’s analytics and reporting capabilities allow for real-time data visualization, helping providers track trends and make data-driven decisions. This includes integrated status, payment, claim details, and historical information.

Advanced Features for Enhanced RCM Power

Availity Essentials Pro stands out with additional features:

  • Predictive Editing: Utilizing AI to pre-emptively identify and rectify claim errors.
  • Comprehensive Claims Processing Options: Including Drop-to-Paper, Workers’ Compensation, and Dental claim processing.
  • EOB to ERA Conversion and Remit Reconciliation: Streamlining the remittance process for enhanced efficiency.

A Partnership for Optimized Revenue Cycle Management

Availity Essentials Pro is more than a solution; it’s a partnership for healthcare providers seeking to navigate the complexities of modern healthcare. Its comprehensive suite of tools, combined with a commitment to innovation and customer support, positions Availity Essentials Pro as a pivotal resource in the journey towards optimized revenue cycle management. In an era where efficiency, accuracy, and financial performance are paramount, Availity Essentials Pro emerges as an essential ally for healthcare providers.

Linda Perryclear is the Senior Director of Product Management at Availity, with responsibility for the Essentials Pro solution and post-submission claims management. Since joining Availity in 2004, Linda has held various positions in the organization including director of the provider support organization, as well as roles in client experience and account management. Throughout her career, Linda has worked in healthcare in both administrative and clinical roles, and also served in the US Navy for six years as a hospital corpsman. She holds a bachelor’s degree in finance and risk management from UNC Charlotte and works from her home base in North Carolina.

To learn more about Availity Essentials Pro and other revenue cycle services, please contact Linda at [email protected] or visit https://marketing.availity.com/rcmlifeline.