There are three key steps to obtaining an authorization: determining if one is needed, submitting it if it is, and obtaining the authorization from the payer. Availity Authorizations addresses all three.
Step 1: Determination
When the pre-certification specialist schedules the procedure in the EHR/RIS, an HL7 feed is automatically sent to Availity, where the CPT-specific authorization is checked against both our robust knowledgebase and the payer site. If an authorization is not required, the confirmation is sent back to the EHR/RIS. Otherwise, the process moves to submission.
Step 2: Submission
In approximately 20 percent of cases, an authorization can be submitted without additional clinical input. In those cases, Availity Authorizations first checks the payer site to see if the authorization has been submitted by the referring physician. If not, the authorization is submitted and moves to the next stage in the process.
When an authorization requires clinical intervention, Availity Authorizations places the case in pending status, so the pre-certification staff know it needs attention. The pre-certification specialist then opens the case and Availity Authorizations automatically connects to the correct payer and pre-populates much of the information, so the specialist can quickly input the clinical information and submit.
Step 3: Retrieval
Once the authorization has been submitted, Availity Authorizations continues to ping the payer behind the scenes until it receives notification. Then it returns the authorization approval number, valid dates, and an archived screen capture via HL7 to the EHR/RIS.
Reduce cost by redeploying staff members and decreasing denials.
Improve yield by increasing operational efficiency and scheduling capacity.
Increase patient and referring providers’ satisfaction.
Streamline staff workflow by eliminating manual processes.
Eligibility, Benefits, and Claims Management
Streamline claims submission and get real-time access to multiple payers at no cost to your facility
Availity’s multi-payer portal gives your facility secure access to multiple health plans, allowing you to check eligibility and benefits, obtain real-time authorizations, check referrals, and more—all at no cost to you. The Availity Web Portal—as it’s known to users—features a streamlined interface, so you only have to log in once to conduct transactions with your contracted payers.
Watch the video on Eligibility, Benefits, and Claims Management
Eligibility and benefits inquiries
Real-time authorizations and referrals
Patient cost estimators
Professional and facility claims
Improve productivity by using one website to access multiple payers.
No cost to providers as the health plans covers the cost.
Fewer denials as the result of having real-time access to updated patient and payer information.
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