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Availity

Availity Revenue Cycle Management (formerly known as RealMed).

With the most dynamic feature set on the market, Availity RCM can help your operations thrive at every stage of the revenue cycle.

Provides clearinghouse services for physician practices and hospitals, offers advanced RCM workflow solutions, powerful productivity tools, actionable insights, and an expansive network reach required by medical businesses wanting to gain an edge in an industry constantly redefined by change.

Key Features:

Claims Submission Management

  • Submit claims instantly in standard format reduce or eliminate paper claims.
  • Submit claims in a batch or one-at-a-time, 24/7, to send to the health plan multiple times throughout a day.
  • Ensure your claims take the fastest path to the health plans with our network of direct connections.
  • Get real-time notification of electronic receipts and line-item, detail-level tracking.

Edit/Error Management

  • Benefit from automatic eligibility and benefit checks on all submitted claims, ensuring completeness and accuracy.
  • Identify errors in real time, including HIPAA compliance, NPI, and provider- and payer-specific errors.
  • Quickly see the fields to be fixed, plain-language summaries of each error, and recommended actions for correcting them.
  • Use one standardized correction process for every payer, increasing efficiency for your staff.
  • View error patterns and trends in on-demand reports.

Status Management

  • Determine the status of pended claims with a daily automatic refresh.
  • Use automated searches and sorts to pinpoint claims that need the most attention, including unpaid, delayed, and pended claims.
  • Search claim histories for proof of timely filing.
  • Find highlighted patterns, problems, or delays in full lifecycle displays of individual or batched claims.

Remittance Management

  • Automatically post ERAs in the format required by most practice management systems.
  • Track remits easily with plain-language explanations.
  • Consolidate machine- and human-readable remittances into one common file feed, reducing the number of files to auto-post.

Advanced Claims Editing

  • Create custom edits that fit your organization’s business rules—without the need for highly technical and specialized resources.
  • Create and control your own custom edits, including payer- and provider-based rules.
  • Navigate a series of step-by-step screens for a user-friendly interface that cuts down on the need for programming resources.
  • Reduce denials with customized, up-front, provider-specific error identification.
  • Adapt to all unique provider- and payer-specific rules in any practice-management system environment.
  • Cut down on vendor costs by using a single integrated, standardized workflow.

Comparative Analytics

  • Benchmark your practice’s performance against state and national peers.
  • Provide transparency into your business operations for even more visibility and control over your revenue cycle.
  • Analyze, compare, and monitor key business performance metrics for reimbursement, staff productivity, payer performance, and code utilization.
  • Customize the system per user level, so answers to questions are simple, painless and intuitive.

Denial Management

  • See the detail behind your denial rates to address errors, reduce write-offs, and improve your cash flow.
  • Coordinate your denial management with any practice management or billing system.
  • Quickly identify denial patterns and health plan payment delays.
  • Automatically complete appeal forms for resubmission.
  • Quickly access patient-specific Explanations of Benefits (EOBs) with limited information.
  • Measure practice performance against your peers with benchmark reports.

Secondary Claim Management

  • Easily automate the generation and submission of secondary claims.
  • Electronically submit fully compliant secondary claims to health plans.
  • Automatically query participating Blue Cross and Blue Shield plans for the presence of crossover claims from Medicare.
  • When a paper secondary claim is necessary for a single patient, print an Explanation of Payment (EOP).

Patient Payments

  • Make Availity Revenue Cycle Management your single source to manage patient payments —integrate claim status, payment, claim detail, and history information into a single database.
  • Give patients the option to pay online using a branded website.
  • Process payments for co-pays at the point of service in real-time using a USB card reader or via keyboard entry.
  • Integrate your payments directly into Availity Revenue Cycle Management, removing the need to use separate, standalone batch terminals.

Patient Statements

  • Use this service to integrate patient statements and pre-collection letter printing with the rest of your claims/payment process, providing the same transparency and common workflows.
  • Submit patient statements and pre-collection letters monthly, weekly, or even daily.
  • Send patient statements as often as you like for next-day processing, in many cases.
  • Choose from a variety of professional statement formats that comply with the Patient Friendly Billing® Project and can be printed on color paper stocks.

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