Availity Blog

Availity Blog

Actionable insights for medical business professionals

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.

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.

Supporting our communities has always been a part of Availity’s corporate culture. By providing a variety of opportunities to give—and by making it easy to participate—Availity cultivates this giving culture among all our employees across multiple locations.

Understanding the needs of customers is paramount to any business’s success. And for Availity, a long-time, trusted intermediary between health plans and providers, understanding and appeasing both segments of the healthcare market has its challenges. Despite the development of integrated digital tools and improved processes and workflows, the relationship between these healthcare stakeholders is historically influenced by friction—even though both recognize a need to work together.

Is your revenue at risk? If your hospital or practice isn’t fully adhering to the risk adjustment and Hierarchical Condition Category (HCC) coding requirements for Medicare Advantage (and some Medicaid) plans, the answer may be yes. Many healthcare organizations underestimate what’s required for these plans and it’s costing them money.

A recent report by CAQH demonstrated that outdated, time-consuming manual processes are still being utilized to exchange information between insurers and providers, particularly financial and administrative data, and it costs us all a fortune. What can we do about this waste? CAQH CORE is a non-profit that brings entities across the healthcare industry together to encourage automation by promoting a common set of rules and underlying standards governing electronic data exchange. To highlight which entities are meeting – or exceeding – these rules and standards, CAQH CORE has developed a certification program.

Join us Friday, 4/14 at 1pm ET for our Assessing Quality Measures tweetchat featuring our own Risk Queen, Susan Bellile (@SKB_RnQ), and The Healthcare IT Guy, Shahid Shah (@ShahidNShah), as we discuss the current and future role of quality measures through technology, legislation, and innovation.

“How well does this vendor integrate with Epic?” It’s an increasingly important question among hospitals and health systems that run Epic and are considering a new claims and clearinghouse solution. It was one of the questions Community Health Network—a non-profit health system with more than 200 sites of care throughout Central Indiana—asked as it sought to consolidate the number of revenue cycle solutions in use across the organization.

Any successful company recognizes the importance of customer touchpoints—those critical moments when a customer engages with someone in the organization. “With the rise of consumerism, healthcare organizations are no different,” says Sarah Holt, a nationally known author and healthcare management consultant. Holt believes that for too long hospitals and physician practices haven’t focused enough on business operations, assuming clinical expertise would make up for any shortcomings.

Last year, Availity, the nation’s largest real-time health information network, participated in a pilot initiative with America's Health Insurance Plans (AHIP) to identify solutions for providing real-time updates and validation of provider directories through a single workflow. See the results!