Availity

Jacksonville, Florida, USA All United States companies → — Founded 2001

Prior Authorization Automation Revenue Cycle / Billing

Family Medicine General Surgery Internal Medicine

Prior Authorization

Late Stage — Undisclosed

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AuthAI

Availity

Prior Authorization

Availity AuthAI leverages transparent, analytical AI to provide real-time, policy-aligned prior authorization recommendations, accelerating the process for healthcare providers and health plans while ensuring compliance and reducing administrative burden.

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About Availity

Availity is a leading healthcare technology company that operates the nation’s largest real-time health information network, designed to simplify and enhance the administrative, financial, and clinical interactions between healthcare providers and health plans. For physicians, Availity serves as a crucial intermediary, streamlining complex workflows that often consume valuable time and resources. Its platform offers a comprehensive suite of solutions, including real-time eligibility and benefits verification, efficient claims submission and status tracking, and simplified prior authorizations. By centralizing these critical functions, Availity helps physician practices reduce administrative burdens, minimize claim denials, accelerate payment cycles, and ultimately free up staff to focus more on patient care.

Furthermore, Availity leverages artificial intelligence (AI) to introduce innovative solutions that redefine traditional healthcare workflows. For instance, AI is applied to enhance prior authorization processes and eligibility checks, aiming to improve accuracy and reduce manual intervention. The company’s commitment to interoperability and intelligent automation means that physicians can expect a more connected and efficient experience when managing patient data, administrative tasks, and financial transactions, fostering better collaboration across the healthcare ecosystem. Availity’s goal is to empower healthcare professionals with the tools, technology, and insights needed to make meaningful business improvements and build thriving organizations in a value-based care environment.

Focus Areas

Healthcare Technology Health Information Exchange Revenue Cycle Management Artificial Intelligence in Healthcare Healthcare Administration Clinical Data Management Financial Transactions in Healthcare Health Insurance Technology Patient Care Solutions Healthcare Workflow Optimization Claims Management Billing EHR Benefits Management Authorizations Interoperability Payer-Provider Collaboration Utilization Management

Business Intelligence

Key Investors	Novo Holdings, Blue Cross and Blue Shield of Minnesota, Prettybrook Partners, Elevance Health (formerly Anthem), Health Care Service Corporation (HCSC), Humana, GuideWell
Partnerships	Abridge (AI-driven clinical conversations), Delaware Health Information Network (DHIN), Vim (care gap notification and closure), Onyx (FHIR-based interoperability for CMS-0057 compliance), Clover Health (Availity Essentials for providers), Iodine Software (machine learning capabilities for revenue cycle management)
Acquisitions	RealMed (2010), RevPoint Healthcare Technologies (2014), Fore Support Services (now Availity India), Diameter Health (August 2022), Olive (Utilization Management Business) (2023)
Technology	Cloud-native (migrating to AWS), AI-enabled workflows, FHIR-native platform, API-driven infrastructure, Electronic Data Interchange (EDI) clearinghouse, Microsoft SQL Server, AWS Managed Services, Microsoft Azure Machine Learning, OpenTelemetry, Salesforce Lightning, Istio, Okta, JSON-LD

What Physicians Need to Know

Revenue Cycle Management (RCM)

Availity offers a comprehensive, full-cycle RCM solution that streamlines operations from pre-service (eligibility, prior authorizations) through post-service (claims submission, real-time tracking, denial management) and post-adjudication. It leverages AI-driven predictive editing to reduce claim denials and accelerate reimbursements.

Health Information Exchange & Interoperability

As a leading real-time health information network, Availity facilitates the secure exchange of vital administrative and clinical information between payers, providers, and HIT vendors. They support core HIPAA transactions and are at the forefront of FHIR-based APIs for interoperability mandates, including CMS-0057-F compliance.

Artificial Intelligence in Healthcare (AI)

Availity utilizes transparent, policy-based 'Analytical AI' (Availity AuthAIu2122) for intelligent utilization management and predictive editing in claims. This AI automates routine tasks, speeds up prior authorization decisions, identifies claim errors before submission, and ensures auditability.

Clinical Data Management

Solutions like Availity Fusionu2122 acquire, standardize, and enrich clinical data from diverse sources (EHRs, labs) into unified, interoperable formats, including FHIR. This enables better decision-making, care coordination, and improved value-based care performance.

Claims Management & Billing

Availity provides comprehensive solutions for electronic, batch, and even paper claims submission, real-time claim status tracking, advanced claim editing, and robust denial management tools. This includes support for various claim types such as professional, institutional, dental, and worker's compensation.

Benefits Management & Authorizations

They offer real-time eligibility and benefits verification, including co-pays, deductibles, and detailed coverage information. Their authorization solutions streamline requests, track status, integrate with EHRs, and leverage AI to accelerate approvals and ensure compliance with mandates like CMS-0057-F.

Payer-Provider Collaboration

Availity acts as a neutral third party, fostering collaboration across its vast network of over 3 million providers and 2,000+ health plans. Their multi-payer portal (Availity Essentials) and 'Payer Spaces' facilitate shared best practices and unified workflows.

Physician Tip

Availity stands out for physicians by significantly simplifying administrative tasks and accelerating critical processes. The **Availity Essentials** portal provides a single, multi-payer platform for real-time eligibility verification, streamlined claims submission and tracking, and efficient prior authorization management, eliminating the need to navigate multiple payer-specific systems. nnPhysicians benefit from **faster reimbursements and fewer denials** due to AI-powered predictive editing that identifies and corrects claim errors before submission, alongside robust denial management tools. The **AI-enabled utilization management (AuthAIu2122)** accelerates prior authorization decisions, reducing administrative burden and allowing more focus on patient care. nnFurthermore, Availity's solutions enhance patient care by providing **real-time access to eligibility, benefits, and comprehensive clinical data**, enabling more informed decision-making and timely care. Their integration capabilities allow these tools to fit seamlessly into existing EHR workflows.

Availity's platform is built for extensive integration, supporting various standards including **X12, REST, and FHIR-based APIs**. This enables seamless connectivity with Electronic Health Record (EHR) systems, practice management software, and other healthcare IT vendors. Their **Availity Fusionu2122** technology specifically facilitates clinical data integration and normalization into interoperable formats. The company's commitment to interoperability is further demonstrated by its proactive solutions for **CMS-0057-F compliance**, ensuring robust data exchange capabilities across the healthcare ecosystem.

At a glance

Founded 2001

HQ Jacksonville, Florida, USA · United States

Team size 1847

CEO Russ Thomas

Funding Late Stage — Undisclosed

Products 1

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Products by Availity

1 product in the directory

AuthAI

Availity

Prior Authorization

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What the Web Says

Availity is a healthcare information technology company that offers solutions to streamline administrative processes between healthcare providers and payers, facilitating the exchange of information in real-time for claims, payments, and patient data. Many providers find Availity Essentials, the free version, to be a valuable tool for checking eligibility, submitting claims, and managing authorizations across numerous payers. However, users frequently report issues with customer service, system glitches, and difficulties with data accuracy and navigation.

Overall: Mixed

Strengths

Free access for providers with core functionality (Availity Essentials).
Centralized portal for eligibility, benefits, claims, and prior authorizations across multiple payers.
Streamlines workflow and improves productivity by reducing the need for individual payer portals.
Easy to access eligibility and benefits, even in real-time.
Good for tracking claims and managing remittances.
Offers tutorials and one-on-one training.

Limitations

Poor customer service with long wait times and unhelpful representatives.
Frequent system glitches, downtime, and technical issues, especially with specific payer portals.
Difficult to navigate and find specific information, such as remits and authorizations.
Data accuracy challenges and inconsistencies with in-house systems.
Limitations in specialized verification, particularly for complex cases like behavioral health.
Some users report poor work-life balance and lower-than-market pay for employees.

Based on reviews from: Capterra, G2, Reddit, Indeed.com, Gartner Peer Insights, VerifyTreatment, Comparably

Last updated: 2026-07-21

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Frequently Asked Questions

How does Availity streamline revenue cycle management, claims, and prior authorizations for healthcare providers?

Availity offers comprehensive Revenue Cycle Management (RCM) solutions, including Availity Essentials Pro, which automate pre-service tasks like eligibility verification and prior authorizations, directly within EHR workflows. It also simplifies post-service claim management through electronic submission, real-time status tracking, and AI-powered predictive editing to reduce denials and accelerate reimbursements.

What are Availity's capabilities regarding health information exchange, interoperability, and EHR integration?

Availity operates as a large health information network, facilitating the secure exchange of clinical and administrative data between payers and providers. They support key interoperability standards such as FHIR, HL7, and C-CDA, and offer solutions like Availity Fusion for clinical data integration and compliance with mandates like the CMS-0057-F Interoperability and Prior Authorization Final Rule.

How does Availity utilize Artificial Intelligence to enhance healthcare administration and utilization management?

Availity incorporates transparent and responsible AI, such as Availity AuthAIu2122, to significantly streamline prior authorization processes by providing real-time, policy-aligned recommendations. This intelligent automation helps reduce administrative waste, accelerates care decisions, and identifies potential claim denials before they occur.

What measures does Availity take to ensure data security and compliance with healthcare regulations?

Availity is HIPAA compliant, encrypts data both in transit and at rest, and enforces strict access controls to protect sensitive health information. They adhere to industry-recognized security frameworks and certifications like HITRUST, and have implemented a 'Rapid Recovery' cybersecurity model to minimize downtime in the event of an incident.

What are the typical pricing models and costs associated with Availity's services for physician practices and healthcare administrators?

Availity offers a tiered pricing structure, starting with a free Availity Essentials plan for basic portal use with sponsored payers. Upgraded services like Availity Essentials Plus, which expands access to non-sponsored payers, typically cost around $25 per month, while clearinghouse services can start from approximately $35 per month, with costs varying based on transaction volume and additional features.

What kind of customer support and implementation assistance does Availity provide to its users?

Availity offers dedicated client services accessible via phone and online support tickets for assistance with Availity Essentials, Essentials Plus, and EDI Clearinghouse services. They also provide onboarding support, training resources, and webinars to ensure smooth integration and optimal utilization of their platforms.

What is Availity's market position and company stability, and who are their key partners?

Availity is recognized as the nation's largest real-time health information network, processing billions of transactions annually and connecting over 2 million providers to health plans. They are a stable company, backed by investments, and partner with various healthcare stakeholders, including major payers, EHR vendors, and technology companies like Salesforce and Onyx, to drive innovation and compliance.

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