Availity Blog

Availity Blog

Actionable insights for medical business professionals

In this episode of Availity Access we discuss solutions that can streamline data sharing processes and reduce manual workflows for payers and providers.

In this episode of Availity Access we discuss how automation has affected the claims submission and processing activities for payers and providers.

Availity Access provides a glimpse into the people behind our products. It features commentary on challenges facing the healthcare industry and how Availity can help providers and health plans better share patient information. In this episode we discuss big data and the challenges it presents for risk adjustment.

Risk adjustment is used to calculate the underlying health status of a health plan’s population. For Medicare Advantage, it is the most significant factor in determining a health plan’s reimbursement. For exchange plans established under the Affordable Care Act (ACA), it determines whether the plan will receive additional funds or be asked to pay additional money at the end of the year.

The Care Cost Estimator is another example of how healthcare organizations are using APIs to facilitate communication between health plans and providers—without having to develop custom solutions. Not only do APIs reduce development time and costs, but they helps plans deliver more accurate estimates to providers and their patients.

MACRA offers multiple pathways with varying levels of risk and reward for providers to tie more of their Medicare payments to value. It’s important for providers to demonstrate value because they’re rewarded for giving better care not just more care.

It seems like every day there’s a different news story about millennials. What they buy. How they communicate. How to work with them. Not since their parents—the baby boomers—came of age have we seen this level of media interest in a generation.