The Availity ® Health Information Network: Capabilities and Connectivity Supporting the Next Generation Revenue Cycle Good for Health Plans, good for Delivery.

The Availity® Health Information Network:

Capabilities and Connectivity

Supporting the Next Generation Revenue Cycle

Good for Health Plans,

good for Delivery Systems,

and good for Patients

Migration to value-based programs and payment models demands:

Inpatient Information• Admissions• Concurrent Review• Lab Results• Discharge Information

Medical Attachments

Clinical Summaries

As well as expanded integrationand connectivity with:• HIEs• Hospital/physician systems• Health plans

Tomorrow’s InformationNeeds

Today’s InformationExchangelargely consists of:

EDI/HIPAA Transactions• Claims• Eligibility & Benefits• Claim Status• Remits

Physician Self Service• Web portals• Real-time information• Care management tools

Revenue Cycle Management• Advanced claims management

for physicians and health plans

Focus on Impact

Impact Requires Provider AdoptionProvider Adoption Requires Demonstrable Value and Simplicity

Simplicity is Achieved via Workflow IntegrationWorkflow Integration is Accelerated by Use of Standards

Adherence to Standards Can Drive Impact

Clinical Documentation

Overview

ProvidersHospitalsMedical AttachmentsClinical SummariesEMR Integration with

Availity® CareProfile®

The Availity Network

Health Plan

AdmissionConcurrent ReviewLab ResultsDischarge InformationMedical Attachments

Clinical Data

Clinical Data

Clinical Data

Clinical Data

Clinical Data

Integrated Clinical Documentation Value Propositions

Cost / Quality / Compliance

Care CoordinationRevenue Cycle

Care ManagementPCMH / ACO

Risk ManagementHEDIS / Stars

Administrative Savings

Inpatient Information Exchange

Integrated Authorizations

Displays status of authorization

Displays Patient Acct #, Patient Name, Medical Record #

Displays facility name, health plan info Quick

search

Displays Patient Class, admit date, discharge date, diagnosis

Displays auth responses, ADT message data, user comments by patient

Refresh screen

Exports to .csv file Allows user to set filters

by facility, date, auth status or health plan

Integrated Discharges

Medical Attachments

Clinical Summaries for Care Managers

• Provider NPI, Name, Group Name

• Patient Name, DOB, Member ID

• Allergies

• Date of Service

• Chief Complaint

• Problem List

• HPI

• Review of Systems

• Assessment and Plan

• Medications

• Progress Note

• Diagnoses

• Consult

• Procedure Codes (CPT, HCPCS)

EMRsAllscripts

Athenahealth

eClinicalworks

Epic

GE Healthcare

Greenway

MedPlus

NextGen

Vitera

Structured data CCDc32

Availity® CareProfile®

with EMR Integration

Integrated Clinical Documentation Value Propositions

Cost / Quality / Compliance

Care CoordinationRevenue Cycle

Care ManagementPCMH / ACO

Risk ManagementHEDIS / Stars

Administrative Savings

Good for Health Plans,

good for Delivery Systems,

and good for Patients

The Availity® Health Information Network:

Capabilities and Connectivity

Supporting the Next Generation Revenue Cycle

Thank you

[email protected]