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Close the gap before the chart chase begins. 

Availity helps health plans capture the evidence earlier, in the workflows providers already use, so care gets credit when it counts. 

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Healthcare has a care gap documentation problem. 

Health plans identify potential care gaps when the data available to them does not confirm that recommended care was completed. But a gap in the data does not always mean a gap in care. 

In many cases, the service has already been delivered, yet the clinical evidence needed to verify it is delayed, incomplete, or inaccessible across disconnected systems. Quality teams are left relying on retrospective chart chase to find and validate records, adding administrative work for providers and health plan teams while the measurement-year deadline approaches. 

Availity helps health plans capture, validate, and deliver the evidence needed to close gaps earlier, in the workflows providers already use 

Care gaps have become a strategic business priority.

Clinical outcomes matter more

Stars performance is increasingly tied to verifiable clinical outcomes, margin protection and executive priorities.

Chart chase is becoming obsolete

The industry can identify gaps. The challenge is capturing evidence before expensive retrospective recovery begins.

Data quality is the new battleground

Improving data quality earlier in the process creates stronger evidence capture, better reporting and improved outcomes.

Digital quality is here

Digital HEDIS®, dQMs and interoperability initiatives are raising expectations for trusted, structured clinical data.

Why Availity

Close the gap between care delivered and care documented

Neutral network

A trusted intermediary connecting payers and providers across the healthcare ecosystem. 

Embedded workflows

Providers work inside workflows they already use with Availity. No additional portals. No new systems. 

Provider reach

A unique combination of provider portal and claims clearinghouse access creates engagement opportunities competitors struggle to replicate. 

Digital-quality-ready data

Clinical data normalization and interoperability capabilities help organizations prepare for the future of digital quality measurement and reporting.

Clinical Quality Validation (CQV)

Capture quality evidence while it still counts toward HEDIS® performance.

Providers shouldn’t have to leave their workflow to close care gaps. CQV delivers care gap notifications and documentation submission through the Availity Essentials portal, enabling providers to take action in a familiar environment instead of navigating disconnected systems, paper forms, or fax-based processes. 

The result is earlier evidence capture, less provider abrasion, reduced chart chase, and stronger quality reporting built on documentation that arrives when it can still make a difference. 

Key Benefits

  • Embedded in a workflow providers already use 
  • Supports year-round documentation capture 
  • Reduces chart chase and administrative burden 
  • Creates a consistent multi-payer experience 
  • Supports quality reporting and HEDIS® performance initiatives  

Risk Condition Validation (RCV)

Improve risk documentation accuracy before it becomes a retrieval scramble.

RCV allows health plans to communicate member-specific risk gaps through Availity Essentials and collect supporting documentation directly from providers. Providers can validate conditions, submit documentation, or indicate when a condition does not apply. 

RCV replaces manual chart retrieval and paper-based outreach with structured provider workflows that support more accurate and defensible risk documentation. By supporting year-round validation, health plans can reduce late-cycle retrieval activity while improving risk accuracy and audit readiness.  

Key Benefits

  • Structured provider responses 
  • Reduced manual chart retrieval 
  • Improved documentation accuracy 
  • Better audit readiness 
  • Reduced provider burden across multiple payers 

Humana + Availity: From Manual Chart Chase to Digital Evidence Capture 

A large national deployment demonstrated what happens when quality validation moves into provider workflow. Providers were able to submit documentation through an integrated, multi-payer experience, reducing reliance on retrospective recovery. 

Results included: 

  • No-match rates reduced from 15% to less than 1% 
  • 55,000+ HEDIS® measures submitted through workflow-embedded validation 
  • Two care gaps closed per submission on average 
  • Provider adoption increased from 25% to 70% 
View Case Study

Explore resources designed to help health plans think differently about care gap closure.

Blog

High-Quality Clinical Data Has the Potential to Transform HEDIS Quality Reporting and Close Care Gaps
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Case Study

How a Health Plan Closed Care Gaps and Increased Provider Engagement with Electronic Clinical Quality Validation
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