Availity Revenue Cycle Management For Practices & Medical Groups
Authorizations

Authorizations. Get answers in minutes, not days

Availity Authorizations automates the prior authorization process, making it faster and easier to receive confirmation from the health plan. Instead of waiting days and following up via phone, fax, and email, your staff can determine almost immediately whether an authorization is required, submit it, and receive confirmation.

When authorizations are automated, your staff is freed up to work on more high-value activities and your organization can maintain operations at peak capacity. Getting answers quickly also helps improve patient satisfaction.

Three-step authorization process

There are three key steps to obtaining an authorization: determining if one is needed, submitting it if it is, and obtaining the authorization from the payer. Availity Authorizations addresses all three.

Step 1: Determination

When the pre-certification specialist schedules the procedure in the EHR/RIS, an HL7 feed is automatically sent to Availity, where the CPT-specific authorization is checked against both our robust knowledgebase and the payer site. If an authorization is not required, the confirmation is sent back to the EHR/RIS. Otherwise, the process moves to submission.

Step 2: Submission

In approximately 20 percent of cases, an authorization can be submitted without additional clinical input. In those cases, Availity Authorizations first checks the payer site to see if the authorization has been submitted by the referring physician. If not, the authorization is submitted and moves to the next stage in the process.

When an authorization requires clinical intervention, Availity Authorizations places the case in pending status, so the pre-certification staff know it needs attention. The pre-certification specialist then opens the case and Availity Authorizations automatically connects to the correct payer and pre-populates much of the information, so the specialist can quickly input the clinical information and submit.

Step 3: Retrieval

Once the authorization has been submitted, Availity Authorizations continues to ping the payer behind the scenes until it receives notification. Then it returns the authorization approval number, valid dates, and an archived screen capture via HL7 to the EHR/RIS.

Expert advice from Pre-Certification Support Team

Technology can make life a lot easier, but sometimes you still need to talk to an experienced professional. Availity’s pre-certification support team can answer questions that an interface alone simply can’t.

As an example, if a patient’s benefits suggest a prior authorization isn’t required but Availity Authorizations indicates that it is, our team can evaluate the payer rules and the data feed to determine why there might be a discrepancy. Availity’s deep understanding of claims processing and denial trends helps your team get answers quickly at each stage of the authorization process.

 

Benefits

  • Reduce cost by redeploying staff members and decreasing denials.
  • Improve yield by increasing operational efficiency and scheduling capacity.
  • Increase patient and referring providers’ satisfaction.
  • Streamline staff workflow by eliminating manual processes.
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