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Maximize Payments, Streamline Workflows

As the business of healthcare becomes more complicated, hospitals and physician practices need solutions that make it faster and easier to manage critical workflows throughout the entire revenue cycle, to prevent denials, and to receive payments faster without placing additional burden on existing staff.

Maximize Payments, Streamline Workflows

Availity Essentials Pro’s revenue cycle solution simplifies claim and payment processing while delivering intelligent reporting and analytics that pinpoint revenue cycle trends.

Content Summary

Pre-service data quality
Powerful post-service claims management
Denial prevention and denial management
Expansive post-adjudication tracking and reporting
Additional modules to increase your revenue cycle power

Pre-service data quality

Many issues related to claim denials and patient payments can be traced back to problems at the front of the revenue cycle. Availity Essentials Pro helps you address these gaps with tools that eliminate the manual processes that slow down the registration process.

Eligibility and Benefits

Access eligibility and benefits information throughout the entire revenue cycle—either from within the Essentials Pro user interface or through a real-time integration within your practice management or EHR workflows.

Patient Collections

Give your patients a branded online payment option that allows you to process credit cards through the application.

Self-Pay Eligibility

Identify potential patient coverage options under Medicaid and major payers with this pre-service additional module.

INTEGRATION AND WORKQUEUE OPTIMIZATION

Availity Essentials Pro seamlessly integrates with a number of PM, HIS, and EHR platforms. Availity consistently ranks highly with Epic customers and offers deep integration experience and expertise both during your implementation and beyond.

Powerful post-service claims management

You can’t let mistakes during the claim submission process affect your ability to get paid. Availity Essentials Pro helps prevent errors, while providing analytical tools that improve organizational insight.

Claims Submission

Submit claims in a batch or one at a time in standard and non-HIPAA standard formats and receive real-time notification and claim level tracking.

Edit/Error Management

Before claims are submitted, identify errors in real time such as those related to HIPAA compliance, eligibility, coding, and payer-specific rules. Errors are presented in an easy-tounderstand format, along with recommended actions for correcting them.

Denial prevention and denial management

Don’t just manage denials—take active steps to prevent them. Availity Essentials Pro offers a suite of products and services to give you flexibility in developing end-to-end denial strategies that fit your organization.

Denial prevention: Tackle the root cause of denials with tools and services that deliver a multifaceted approach, including front-end claims editing, payerspecific edits, and more.

Denial management: As part of your core Essentials Pro service, your integrated appeals workflow allows you to assign, organize, and work denials all with real-time analytics and pattern reporting. Availity Essentials Pro also offers outsourced service options.

OUR CUSTOMERS SAY IT BEST

“Availity has the expertise to go deep with customers and help solve complex revenue cycle challenges, all the way through our Epic workflows. An extra hour in our day to work on other high-value activities is huge, and reducing paper takes away a major headache.” — Latricia McKinnie, Reimbursement Specialist, Duke Health

Expansive post-adjudication tracking and reporting

Claim Status and Tracking

Automatically track claims in real time until claims are in a final status. Availity Essentials Pro matches back payments from 835s to claims submitted for enhanced claim information. When available, you can also receive payer-specific, value-added information. The search feature lets you easily find claims across all statuses, with relevant history. Claim status data can also be integrated within your practice management system.

Remittance

View or print individual claim payments, or the whole file. Receive ERA files in formats that allow your practice management system to automatically post payments and easily track remits received. View PDFs of all remittances received.

Patient Statements and Payments

Integrate the process of sending electronic statements and printing pre-collection letters and statements right into your Essentials Pro workflow. Easily process all forms of payment, set up payment plans, and run reports all with a comprehensive patient payment portal.

Analytics and Reporting

Get status, payment, claim detail information, and more in a complete analytics suite that provides a comprehensive look into your organization’s performance. With the ability to visualize your data in real time, you can ensure you are getting the custom data you need before generating your reports. You can also identify errors and prevent denials by evaluating denial patterns through claim level reports.

Additional modules to increase your revenue cycle power

Availity Essentials Pro offers several additional modules to further empower your revenue cycle management:

  • Take claims submission functionality to the next level with several options including: Drop-to-Paper for primary or secondary claims, which generates CMS 1500 and UB-04 forms along with Explanation of Payments (EOP), and prints and mails claims on your behalf; Workers’ Compensation & Automobile Liability claims processing which connects you to 2,800 non-healthcare organizations that accept and process claims; Integrated Dental claim submission which allows you to connect with dental payers; Availity Generated Secondary Claims, which automates secondary claims; Enhanced Medicare Status which provides FISS claim status without leaving your workflow; 276/277 Claim Status updates that accelerate your cash flow; and All-Payer Attachments which helps you consistently submit attachments for both professional and institutional medical claims.
  • Need further help with remittances and denial information? EOB to ERA Conversion creates ERAs from paper payments that can be automatically posted by your practice management system; Remit Reconciliation Services automatically matches the EFT with the ERA and releases remits when reconciliation is complete; Lockbox Services automates the process of depositing, posting, and managing paper payments; and Comparative Analytics helps you identify denial patterns.

WHY AVAILITY

Availity is the place where healthcare finds the answers needed to shift focus back to patient care. As one of the nation’s largest health information networks, Availity facilitates billions of clinical, administrative, and financial transactions annually. Our suite of dynamic products, built on a powerful, intelligent platform, enables real-time collaboration for success in a competitive, value-based care environment.

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