April 18, 2017 – Availity, the nation’s largest real-time health information network, announced the launch of its automated prior authorization platform, which eliminates the cost, time, and administrative burdens associated with manual authorization processes.
Availity Authorizations utilizes a HIPAA-compliant, secure cloud platform to automatically check if a prior authorization is required or has been obtained. The platform also helps provider organizations avoid costly denials by ensuring that services are rendered only when an authorization has been approved.
Manual authorization requests can take weeks to fulfill and require hundreds of thousands of man-hours to track and complete. Financially, each manual prior authorization, on average, costs providers $5.61 more than an electronic transaction.
Powered by an engine of more than 300,000 rules and Availity’s network of more than 1,100 payers, Availity Authorizations automatically checks CPT-eligibility and benefits, payer edits, and client history, ensuring users don’t waste time when an authorization isn’t required. Additionally, investing in fully electronic authorizations prepares provider organizations as more payers include electronic transaction capabilities in provider contractual agreements.
Availity Authorizations’ rules-based functionality also streamlines front-office workflow, allowing office staff to eliminate fax- and web-based tasks in favor of real-time submission of authorization requests, and reduces the prior authorization process from weeks to minutes. If an authorization cannot be obtained automatically, the solution helps the provider team members answer clinical questions by automating the remaining steps required to obtain an authorization.
Other key functionality includes email alerts based on defined parameters; integrated, intuitive dashboards for managers to monitor and control flow cases; and a ‘touchless’ experience for many authorizations, allowing users to work only those that require manual intervention.
According the 2016 CAQH Index, an annual report of the adoption of electronic business transactions, provider organizations could save more than $412 million by adopting automated, electronic authorizations.
“Availity Authorizations allows our customers to automate the entire authorizations process—from requesting a prior authorization to confirming its status—ensuring that providers optimize their bottom lines without the labor-intensive bottlenecks of manual processes,” said Russ Thomas, Availity CEO. “Paired with Availity’s Patient Access platform, providers will have a robust and comprehensive suite of solutions to face the rising challenges of new payment models and increased financial responsibility on the part of patients.”
Availity acquired the solution from El Paso, TX-based FORE Support Services, LLC, a software company that develops solutions for automated pre-authorization clearances. Availity Authorizations will initially be launched for radiology and imaging units.
To learn more about Availity Authorizations, click here.