Availity Resource Library

Health plans rely on accurate patient data from their providers to complete risk adjustment processes and quality programs required by the government. Learn how digital tools make collecting risk and quality information easier.

From the rise of the sharing economy to the ubiquitous selfie, trends embraced by millennials are changing our culture in many ways. How might they change healthcare?

This white paper examines five urgent challenges health plans face as they work to improve the quality of their provider data, and offers four steps plans can take to get started on the journey.

Inaccurate information about providers has long been a problem for the healthcare industry—as many as 50 percent of entries in provider directories are inaccurate. These inaccuracies drive administrative costs up, but health plans don’t realize how much of their costs are associated with bad provider data.

The challenge health plans face with capturing and maintaining accurate provider data is that it’s both complex and dynamic. Assessing the people, processes, and technology involved in capturing and maintaining provider data will provide perspective on which areas you should focus on first.

This infographic provides a snapshot of how inaccurate provider data affects everyone in the healthcare system.

Processing claims isn’t the most glamorous job. Multiple times each day, some the same issues might pass by your desk. See how one claims VP identified a realistic, cost-effective solution to claims errors for her health plan, reducing administrative costs and saving the day.

With more of the financial responsibility of care shifting to the patient, savvy healthcare professionals are working to fine-tune their patient collections strategies. This e-book provides best-practice guidance from our team of Availity experts as well as lessons learned from our most successful customers.

This study, sponsored by Availity, was conducted to obtain current feedback on the challenges, experiences, and attitudes of providers related to payment reform initiatives. A follow up from a 2013 report, this study includes key findings and provider viewpoints around the shift to value-based payments.

This study, sponsored by Availity, was conducted to obtain current feedback on the challenges, experiences, and attitudes of health plans related to payment reform initiatives. A follow up from a 2013 report, this study includes key findings and health plans viewpoints around the shift to value-based payments.

The shift to value-based payment models has broad support and is growing. In fact, Availity research indicates 2018 could be a tipping point where over half of health plan revenue comes from value-based contracts.

When change happens quickly, it can be difficult to assess whether or not existing processes are working. This is the case for many hospitals and physician practices trying to adapt to value-based payment models, high-deductible health plans, and shrinking payer reimbursements.

There’s a demographic shift happening in the U.S. as last year the millennial generation overtook Generation X to become the largest segment of the U.S. workforce. In response, companies are redesigning products and services to better meet the needs of millennials. Find out what this means for healthcare providers.

“Big data” holds tremendous promise for the healthcare industry as it transitions to value-based care. With technology advancements and the increased volume of healthcare data collected, many believe we are close to finding better ways to measure value and assess risk.

Faced with increasing accounts receivable and decreasing patient collections, Anderson Medical Center knew they needed a better way to capture patient collections upfront. Find out how they increased opportunities to collect the patient responsibility by 60–70 percent.

As the volume and variety of health insurance products increase to accommodate an expanding market, so do concerns about the accuracy of provider network information. This webinar includes the CMS guidance concerning provider directories and data elements most critical to effective provider data management.

Not ready for ICD-10? This infographic provides a number of resources for a variety of readiness scenarios facing providers and health plans.

Implementing an EHR requires a substantial commitment of resources, so it’s important to get it right. With EHR-giant Epic, Availity offers one of the most integrated Revenue Cycle Management (RCM) solutions on the market.

It’s no secret that for years, hospitals have struggled for an easy way to share information about patient admissions, discharges, and transfers with health plans, and that health plans have struggled equally to obtain this information on a timely basis. Digitizing ADT notifications and treatment authorizations offer great opportunities to achieve better quality care, lower costs, and improved outcomes.

In follow-up to the first roadmap for healthcare information exchange produced by WEDI in 1993, the 2013 report provided a framework for the next generation of healthcare information exchange that would lower healthcare costs, improve healthcare delivery, and achieve better healthcare outcomes.

From declining Medicare reimbursements and growing numbers of high-deductible health plans, to the introduction of value-based payment models, managing financial performance has become trickier than ever for providers.

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A growing family of physicians with 600 providers in practices spanning 11 counties, Carolinas HealthCare System faced rising claim error rates, which peaked at 7.5 percent. To bring the claim edit backlog to zero in less than a year, they turned to Availity.

Asheville Anesthesia Associates faced a growing accounts receivable file and a payment collection process that was too slow. See how Availity helped them to improve practice efficiencies and their overall financial position.

See how Adventist Health System, a faith-based, not-for-profit hospital organization whose sheer growth and geographical spread made conditions ripe for inconsistent billing practices and disparate systems across its multiple billing offices, looked to Availity to standardize processes, reduce claim denials, and strengthen health plan connectivity.

As claim volumes surpassed more than $300 million in annual billings, American Health Network found itself facing one of the most vexing problems in healthcare—claim denials. A five-year Availity clearinghouse customer already impressed with Availity’s expertise and guidance with claims management, AHN looked to Availity to help manage denials.

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