Availity AuthAI

by Availity  · Based in United States → — AI-Powered Prior Authorization Built for Better.
Family Medicine Hospital Medicine Internal Medicine
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Regulatory Status Disclosed

Overview

Availity AuthAI is an AI-powered solution designed to transform the prior authorization process, reducing administrative burden and accelerating patient care. It leverages transparent, policy-based analytical AI to provide real-time, auditable recommendations for prior authorizations, grounded in a health plan’s medical criteria, rather than relying on predictive models or historical guesses. This solution is a component of Availity’s Intelligent Utilization Management offering, aiming to streamline the entire prior authorization workflow from intake and submission to determination and feedback. Availity AuthAI integrates with existing EHR systems and the Availity multi-payer portal, providing a consistent experience for providers and helping to meet CMS-0057 Final Rule compliance.

Reviewed by Pouyan Golshani, MD — Interventional Radiologist

Key Features

  • AI-powered prior authorization recommendations
  • Real-time authorization decisions
  • Policy-based AI (analytical AI, not generative AI)
  • Traceable and auditable recommendations
  • FHIRu00ae-native platform for interoperability
  • Integration with EHRs (Epic, Cerner, athenaOne, etc.)
  • Multi-payer portal access
  • Coverage Requirements Discovery (CRD)
  • Documentation Templates and Rules (DTR)
  • Prior Authorization Support (PAS)

Use Cases

  • Automating routine prior authorization requests
  • Expediting prior authorization decisions for critical care
  • Reducing administrative burden for providers and payers
  • Improving compliance with CMS-0057-F regulations
  • Streamlining utilization management workflows
  • Enhancing payer-provider collaboration

What Physicians Need to Know

Payer Coverage Scope
Availity has a nationwide network of payers, directly connected to 95% of health plans and serving over 3.4 million providers.
Denial Rate Reduction Data
Availity AuthAI has shown a 95% reduction in appeals and grievances related to prior authorizations. Availity's Predictive Editing tool, part of their RCM platform, flagged over $828 million in denials with 97% precision in a proof-of-concept study. Another case study demonstrated a 67% reduction in eligibility denials.
Auto-Appeal Capability
Availity's RCM solutions include denial management and appeals, allowing providers to submit and monitor claim appeals through Availity Essentials.
CPT/ICD-10 Code Suggestion
While not explicitly stated as CPT/ICD-10 code suggestion, Availity AuthAI uses Natural Language Processing (NLP) to pull key details from clinical notes, ensuring requests have the right information. It also leverages payer medical policies and presents clinical attestation questions to prompt submitters for necessary information.
Real-Time Eligibility Check
Availity offers real-time eligibility and benefit verification through its Essentials and Essentials Pro platforms, integrating directly into EHR workflows. This can reduce eligibility denials significantly.
RCM System Integration
Availity's RCM solution, including AuthAI, integrates seamlessly with hundreds of practice management systems, hospital information systems, and EMR systems. It is platform-agnostic and integrates via FHIRu00ae API to UM systems and any EHR.
Prior Auth Turnaround Time
Availity AuthAI can render prior authorization recommendations in near real-time, averaging less than 90 seconds. Some cases receive first-time approval within 90 seconds, with a median response and resolution time of 27 seconds for the entire process.
Documentation Auto-Attachment
Providers can electronically attach supporting medical documentation through Availity Essentials. The Concurrent Review/Continued Stay feature allows uploading additional clinical documentation for inpatient authorizations. Availity's APIs also enable third-party submitters to add attachments to existing authorizations.
Claim Status Tracking
Availity provides solutions for claim status tracking, allowing providers to check the status of electronic claims through 276/277 transactions and track them from submission through adjudication. Providers can also review pending authorizations for all health plans through a dashboard.
Physician Tip

Leverage Availity AuthAI for faster prior authorization recommendations, often in under 90 seconds, freeing up time for patient care. Utilize the platform's ability to electronically attach supporting documentation and track authorization and claim statuses in real-time to reduce administrative burden and follow-up calls. Ensure your clinical documentation is thorough, as AuthAI uses this data and codified medical policies for its recommendations.

Availity AuthAI is built on a FHIRu00ae-native platform, connecting health plans, providers, and HIT systems through secure APIs, ready for CMS-0057 compliance. It integrates seamlessly with hundreds of practice management systems, hospital information systems, and EMR systems, including direct integration into EHR workflows for eligibility and prior authorizations.

Details

Category Prior Authorization
Pricing Enterprise — Contact Availity or your health plan for pricing information.
DeploymentCloud-based
Compliance
BAA Available Yes AI-estimated
HIPAA Compliant Yes AI-estimated
FDA Status Not applicable AI-estimated

Not applicable for this type of administrative and workflow optimization software.
Integrations
EHR Not specified
Specialties Family Medicine, Hospital Medicine, Internal Medicine

Ratings & Reviews

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Clinical Value
Ease of Use
Integration
Support & Docs
Value for Money

Press & Coverage

AI-Tech Park
Availity Unveils Intelligent Authorization Solution at HLTH 2024
Availity showcased its multi-channel, API-powered intelligent authorization solution at HLTH 2024, aiming to empower providers and payers through innovative technology and streamline prior authorizations. The solution leverages FHIR standards to improve prior authorization management and patient care.
2024-10
Availity
The Future of Healthcare: AI in Prior Authorizations - Availity
This article discusses the role of AI in prior authorizations, highlighting how Availity AuthAI uses Natural Language Processing (NLP) and clinical data to assess submissions against medical policies and recommend decisions in seconds, aiming to make the process more efficient and accessible.
2024-10
Availity
Availity Highlights Authorizations in Seconds with AI
Availity announced at AHIP 2023 its solution to accelerate prior authorizations from days to seconds using AI and clinical data, aiming to overcome common barriers and improve timely care delivery. The company also hosted a panel discussion on leveraging AI for prior authorizations.
2023-06
Availity
Simplifying the Prior Authorization Process through Automation - Availity
This article details a collaboration between Availity, Blue Cross and Blue Shield of Minnesota, Itiliti Health, and a healthcare provider to develop Intelligent Utilization Management (formerly AuthAI), which significantly decreased authorization requests and improved efficiency.
2023-08
Availity
Transforming Prior Authorizations with AI-Powered Automation - Availity
Availity discusses how AI-powered automation can transform prior authorizations by standardizing and integrating administrative and clinical data to make the workflow more efficient and reduce delays in patient care.
2024-02
Availity
Innovative Approaches and the Underlying Technology Used to Develop Availity AuthAI
This webinar description highlights how Availity AuthAIu2122 uses Natural Language Processing (NLP) and clinical data to assess prior authorization submissions against medical policies, delivering speed and accuracy.
2024-05
Availity
Availity Applauds Industry Commitment to Modernize Authorizations
Availity celebrates the commitment of leading health insurers to modernize the authorization process by 2027, emphasizing its FHIR-native Intelligent Utilization Management solution that delivers authorization results rapidly.
2025-06
Availity
New MedCity Article: Insights on Why Automating Prior Authorization Requires Digitizing Medical Policy | Availity
An article by Matt Cunningham of Availity in Medcity News explains that automating prior authorization requires moving beyond static digitized medical policies to clinician-aligned, machine-executable decision trees for scalable automation.
2026-05

Videos

Product demos, reviews, and walkthroughs for Availity AuthAI.

View all on YouTube

Frequently Asked Questions

Availity AuthAI streamlines prior authorization by using analytical AI to apply health plan policies and clinical guidelines in real-time, which helps automate routine cases and provides quick recommendations. This reduces manual tasks, phone calls, and faxes, allowing staff to focus on more complex cases and patient care, ultimately leading to faster approvals and fewer claim denials.
Yes, Availity AuthAI is designed with compliance in mind, particularly for CMS-0057-F, which mandates electronic prior authorization. It uses transparent, analytical AI that ties every decision to policy, making it auditable and explainable. This approach ensures regulatory readiness and helps health plans meet interoperability and timeliness requirements.
Availity offers a free 'Essentials' tier that covers basic eligibility, claims, and authorizations for participating payers. However, for Availity AuthAI and expanded services, pricing is typically enterprise-level and not publicly published. Costs can vary based on transaction volume, the number of providers, and the need for advanced integrations or non-sponsored payers.
While Availity AuthAI excels at providing fast, auditable recommendations and connectivity, it's primarily a recommendation engine, not a decision-making one, meaning it doesn't auto-deny or approve prior authorizations. Its strength is in connecting with health plans and providing an audit trail, but it may not fully automate the creation of a complete procedure packet from a patient's visit, which some specialized tools offer.
Yes, several alternatives exist, each with different strengths. Some include Cohere Health, which focuses on clinical intelligence and high real-time approval rates; Waystar, integrated with RCM stacks; Myndshft, an end-to-end automated platform; and Insight Health, which builds authorizations from the patient visit in real-time for specialty clinics. Other options like CoverMyMeds are strong for pharmacy prior authorizations.

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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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Suggest an Edit → | Last Verified: 2026-08-23 | First Added: 2026-08-23
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