Availity Blog

Availity Blog

Actionable insights for medical business professionals

Your health plan has enough claims to process without adding ones that don’t belong to your organization. But that’s what happens when claims with invalid member or provider IDs enter your adjudication system. Internal resources can spend significant time working these before the error is discovered, which means higher staffing and administrative costs.

Availity understands that if you want to drive provider engagement, you need to find new ways to automate healthcare transactions. That’s why we are introducing two new automated workflows within our Provider Engagement Portal: appeals and overpayments.

Join us Friday, 11/10 at 1pm ET for our tweetchat, Confidence Through Compliance, featuring our favorite HIPAA lawyer, Matt Fisher (@Matt_R_Fisher), and our Availity compliance guru, Erika Ables (@Erika_Ethics), as we discuss how compliance can enhance everything in healthcare from cybersecurity to patient interactions.

In this edition of Availity Access, Mark Martin, product line director for provider data, discusses why addressing credentialing is the next logical step in Availity’s work to simplify data verification and improve the quality of provider data throughout the health care data ecosystem.

Working in healthcare guarantees you’ll be interrupted multiple times a day, whether it’s by staff, patients, physicians, or health plans. Fortunately, there are some tasks that can be completed on your timeline. Even better, when you get ahead of them you can greatly reduce the number of interruptions you face.

Availity recently commissioned an independent research company to survey providers—physicians and non-medical staff, in practices and facilities—about their credentialing process. No one should be surprised that providers are not happy with how it’s conducted.

“If you see this text, then your files are no longer accessible because they have been encrypted.” This is the on-screen message many organizations and individuals saw Tuesday, June 27 when a massive cyber-attack froze thousands of computers, especially in Ukraine, Russia, and the U.S. The message went on to demand $300 in Bitcoin as ransom, promising to employ a decryption service upon payment. The attack, originating in Ukraine, affected a number of large companies—and at least one U.S. hospital—resulting in millions of dollars in lost revenue and disruption.

Join us Friday, 10/13 at 1pm ET for our tweetchat, Healthcare Credentialing: The Good, the Bad, and the Scary, featuring Michelle Barry, our expert of health plan provider data management, Don Lee, president of Glide Health IT, and Shahid Shah, The Healthcare IT Guy, as we discuss what processes and tech can remove the dread that looms around healthcare credentialing.

The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) was passed to make healthcare delivery more efficient and to protect the privacy of patients. In general, HIPAA does not distinguish between physical and mental health in protecting patient privacy. While some advocates argue that not distinguishing between physical and mental health is the only way to protect the privacy of those with mental illnesses, others, including many families with loved ones suffering from mental illness, argue that excluding family members from mental health records can have a devastating effect on the patient, the family, and the public.

Recognizing the need for greater automation, the CAQH Committee on Operating Rules for Information Exchange® (CAQH CORE®) brought entities from across government and the industry together to develop healthcare operating rules for electronic business transactions.