Intelligent Gateway and Vendor Integration

If you know how much your health plan is paying to manage its transactional data, then you probably know you’re not getting your money’s worth. Perhaps your transactional data is stuck in multiple gateways and you can’t see the big picture. Could be you are struggling with managing thousands of different submitters and multiple edit packages. Or maybe your service center fields countless phone calls from providers because they don’t know who else to call. Whatever the reason, we are glad you are here. And we think that you will be, too.

We help health plans like yours get the most out of their technology. Availity’s Intelligent Gateway has deep relationships with EMR vendors and clearinghouses, so you’ll benefit from the tightest workflow integrations with the least amount of disruption. Just check out our list of Supported Systems to find the technologies most important to your network.

As the single, largest gateway in healthcare, we understand what health plans are looking for in a partner: exceptional customer service, help in identifying trends in transactional data, prompt edit administration, competitive pricing, and an expansive footprint. These are the reasons our Intelligent Gateway customers switch to Availity and why they stay with us year after year.

Availity Intelligent Gateway Patient and Claims Management

Patient Management

The Patient Management Solution allows direct submitters, third-party vendors, and clearinghouses to send an eligibility and benefit inquiry (x12 270) and receive a response (x12 271).

Claims Management

The Claims Management solution allows direct submitters, third-party vendors, and clearinghouses to submit a claim via the x12 837 (I, P, or D) transaction, check the status of a claim via the x12 276/277 transaction, and obtain a cost estimate for a procedure (or set of procedures) by submitting a claim (I and P)-type data in JSON format

Availity Intelligent Gateway Claims Management
Availity Intelligent Gateway Financial Clearinghouse

Financial Clearinghouse

The Intelligent Gateway’s Financial Solution allows payers, third-party vendors, or clearinghouses to transmit a variety of financial and related transactions through Availity, including ERAs (x12 835 and proprietary formats), Premium Payments (x12 820 and proprietary formats), and Member Enrollments (x12 834). Additionally, Availity can facilitate payment processing for payers and providers.

Custom Content

Processing HIPAA transactions is a critical requirement of any gateway, but providers often need more information than these transactions deliver. For example, an eligibility and benefit transaction (x12 270/271) returns member coverage, benefit levels, and co-pay/co-insurance information, but if a provider wants to give the patient a cost estimate for an encounter they must call the plan’s support desk. Availity’s Intelligent Gateway allows you to distribute customized content (cost estimators, deeper claim status information, and other value-added content) to your providers through their vendors.

Availity Intelligent Gateway Custom Content
Availity Intelligent Gateway Services

Drop-to-Paper, Front-End, and Print Fulfillment Services

Availity offers several solutions to help you manage the ongoing challenge of paper-based processing.

  • Drop to Paper: Availity accepts electronic claims (837 I/P/E, 837D, Workers compensation) and converts them to the appropriate paper-based form (CMS 1500, UB04, ADA, etc.), which can then be printed and mailed.
  • Paper-to-Electronic Conversion and Mailroom Services: Availity provides a centralized mailroom service to process all incoming mail from a member or provider, including receiving, opening, prepping, sorting, and converting to an electronic image. We also have a fax and email intake service for forms that come through those channels.
  • Paper Claim Rejections: Availity converts paper claims to an electronic image and evaluates it against a set of rules established by your plan. If the claim does not pass the edits, a paper rejection is created and mailed to the provider.

Reporting

Availity Insights puts robust reporting capabilities in your hands. Rather than log a support ticket to research a problem, you can do a deep dive on your transactions and conduct your own analysis and troubleshooting. Stay up-to-date on the health of your network with a more complete understanding of adoption rates, error trends, and more.

Availity Intelligent Gateway Reporting
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