Clinical Gateway Capabilities
Patient Care Summary
A health plan looking to improve care coordination can send a provider the claim-based insights that the plan has gathered from other providers, from labs, and from pharmacies.
Admission Discharge and Transfer
Today, many health plans receive ADT and 278N information via fax, mail or phone, and many times the ADT is received when it’s too late to impact the patient’s experience. However, Availity connects to the hospitals’ information system and monitors ADT messages, which we can then share via VPN or a SFTP raw data file through our Clinical Gateway.
Lab results are critical for quality measure reporting and for monitoring chronic conditions. Clinical Gateway customers receive lab results (HL7 and custom flat files) via VPN or a SFTP raw data file.
Medical Record Exchange (raw file; without a user interface)
Medical Record Exchange allows health plans to electronically communicate with providers and exchange medical records (x12 277 – 275 and HL7 C-CDA) without using mail, fax or phone, and without having to hire an expensive release of information vendor.
Clinical Gateway + Provider Engagement Portal Capabilities
Medical Record Exchange (with the user interface)
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 attachments, 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 Capabilities
Medical Record Exchange (integration with the vendor's user interface)
Medical Record Exchange allows health plans to electronically communicate with providers and exchange medical records (x12 277 – 275 and HL7 C-CDA) without using mail, fax or phone, and without having to hire an expensive release of information company.