Robust functionality helps improve collaboration

Provider portals are vital for health plans to communicate with providers, helping reduce calls and emails into their support teams. They are also critical to providers because they allow them to run an eligibility and benefits check, view a claim’s status and take appropriate action based on that status, all without picking up the phone and calling the plan. But with increased regulations and ever-present security threats, it’s difficult for health plans to dedicate the budget and resources necessary to maintain these systems in-house.

Availity’s nationwide, multi-payer Provider Engagement Portal helps providers and health plans collaborate and share information easily and efficiently. Providers benefit by having one place to go to accomplish key tasks for multiple plans, and health plans benefit as providers opt for self-service rather than contacting their call centers. Strengthen your relationship with providers through enhanced data and capabilities from the Intelligent Gateway and Clinical Gateway.

See the Provider Engagement Portal in action.

Provider Engagement Portal capabilities

Availity - Provider Engagement Portal Patient Mgmt

Patient Management

The Patient Management Solution is a configurable workflow in which providers can access detailed patient eligibility and benefit information, as well as other pre-service information relevant to the encounter. The Patient Management workflow is the starting point for other Portal workflows, and information generated here is carried over to those workflows, reducing data entry for the provider.

Claims Management

Providers use our Claims Management Solution to research and address issues related to a claim. After checking a claim’s status, providers can follow a series of other workflows, including responding to a plan’s overpayment request, initiating an appeal, sending attachments, and messaging the health plan. And, of course, they can also submit a claim, correct a previously submitted claim, and generate a cost estimate for a member encounter.

Availity - Provider Engagement Portal Claims Management
Availity - Provider Engagement Portal Financial Solutions

Financial Management

With our Financial Management Solution, providers can access detailed ERA information and take payment actions. From our dashboard, providers can easily view their claim payments, exceptions, reversals, and reduced payments across multiple payers. Providers can also process payments here, which includes collecting co-pays and deductibles, and setting up patient payment plans.

Provider Information Management

Health plans use annual contracting and credentialing processes to update provider information records, which means that their provider data is only accurate for one day a year. Relying on these methods leads to out-of-date directories and an inaccurate view of the provider network. Availity’s Provider Information Management Solution features several workflows designed to address the challenge of maintaining up-to-date provider information. Using the Portal, providers can verify key demographic information. After providers attest to data accuracy, Availity sends the updates in real-time or batch to all plans with whom the providers work. Availity ensures each plan receives the data in a format that can be integrated into that plan’s back-end systems.

Availity - Provider Engagement Portal Provider Information Management
Availity - Provider Engagement Portal Provider Engagement

Provider Engagement

Our Provider Engagement Solution gives health plans multiple channels through which to communicate and share information with providers: two-way messaging, home page notifications, news and announcements, and promotions. Health plans use these tools to tell a provider when a medical record is required, to submit an overpayment request or respond to an appeal, to keep an exact record of communication with the provider, (one that’s not subject to a representative’s interpretation or note-taking skills), and for countless other reasons. In addition, the Provider Engagement Solution delivers feedback functionality, giving health plans better insight into what their providers need and want from the plan and the Portal applications.

Authorization and Referral Management

Determining if a prior authorization is required is one of healthcare’s most time-consuming and frustrating processes, and it’s a big source of administrative cost for health plans and providers alike. The Authorization and Referral Management Solution allows providers to manage all aspects of the prior authorization process electronically. Here, providers determine if an authorization is required, enter and submit the prior authorization request, attach medical records (Clinical Gateway required), and view the status of a request.

Learn how Availity's Authorization and Referral Management Solution helped one regional health plan streamline the prior authorization process.

Availity - Provider Engagement Portal Authorization Management
Availity - Provider Engagement Portal Payer Spaces

Payer Spaces

While the Availity Portal is a multi-payer environment, individual health plans still must make proprietary content, such as medical policies and quality reporting, available to providers. Payer Spaces addresses this need by allowing health plans to host plan-specific information from within the Portal via a health plan-branded page. Payer Spaces is both a repository and a platform with its own set of development tools, so health plans can develop (on their own or with Availity’s support) robust applications, allowing them to securely share information with their providers.

Availity 360

Health plans need reliable data about how their provider network is performing to make good decisions. Availity 360 uses administrative data, transactional data and other Portal activity to deliver a clear picture of the network’s health. With Availity 360, health plans can better identify trends and drill down into performance metrics based on payer, transaction type, and more.

Looking to do more with the Provider Engagement Portal? View our Clinical Gateway capabilities.

Availity - Provider Engagement Portal Availity 360

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