Availity, the nation's largest real-time health information network, announced a solution for health plans that need a provider data management solution inside the healthcare provider's workflow. Availity Provider Data Management allows providers to update their critical business information while performing claims-related tasks, keeping revenue flowing and enabling providers to meet health plan and Centers for Medicare and Medicaid Services' (CMS) requirements.
Availity Provider Data Management keeps provider information up-to-date and validated with all of their participating health plans, in addition to proactively delivering notifications when a change is detected. Leveraging automated notifications, this solution reduces administrative burdens on both health plans and providers, addressing core components of value-based payments: reduce administrative costs while improving performance and maintaining a strong and collaborative network of providers.
"Today, plans spend millions retrospectively updating provider data only to have it change during the update process. Providers lose time and money when payments are delayed from this inaccurate information. We're solving that problem in an efficient, effective workflow process" said Russ Thomas, CEO of Availity. "We actively engage with providers on a daily basis to track and validate changes through the Availity Web Portal. We're looking at something larger than a single event--in this case, a comprehensive view of the providers' data--to bring together improved, value-based collaboration between health plans and providers."
The momentum around provider directory maintenance gained steam when CMS strengthened existing benchmarks for provider network data, beginning January 1, 2016. CMS also clarified its expectation that plans participating in Medicare Advantage, Medicaid, CHIP, and federally facilitated marketplaces (FFM) update directories in real-time, and have regular, ongoing communications with providers to ascertain their availability and whether or not they are accepting new patients.
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