The Availity Health Information Network:
Good
for
Health
Plans,
Capabilities and Connectivity
®
good for Delivery Systems,
Supporting and
the Next
good
Generation
for Patients
Revenue Cycle
Tomorrow’s
Information
Needs
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 integration
and connectivity with:
• HIEs
• Hospital/physician systems
• Health plans
Today’s
Information
Exchange
largely 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 Adoption
Provider Adoption Requires Demonstrable Value and Simplicity
Simplicity is Achieved via Workflow Integration
Workflow Integration is Accelerated by Use of Standards
Adherence to Standards Can Drive Impact
Clinical Documentation
Overview
Health Plan
The Availity
Network
HospitalsProviders
MedicalClinical
Attachments
Data
Clinical Summaries
EMR Integration with
Availity® CareProfile®
Clinical
Data
Admission
Concurrent Review
Clinical
Lab Results
Data
Discharge Information
Medical Attachments
Integrated Clinical Documentation
Value Propositions
Cost / Quality / Compliance
Care Coordination
Revenue Cycle
Care Management
PCMH / ACO
Risk Management
HEDIS / Stars
Administrative Savings
Inpatient Information Exchange
Integrated Authorizations
Displays Patient Acct #,
Patient Name, Medical
Record #
Displays facility
name, health plan
Displays status of
info
Quick
authorization
Exports to
.csv file
Refresh
screen
Allows user to set filters by
facility, date, auth status or
health plan
search
Displays auth
responses, ADT
message data,
user comments
by patient
Displays Patient Class, admit
date, discharge date, diagnosis
Integrated Discharges
Medical Attachments
Clinical Summaries for Care Managers
Structured data CCDc32
•
•
EMRs
Allscripts
Provider NPI, Name,
Group Name
•
Review of Systems
•
Assessment and Plan
Patient Name, DOB,
Member ID
•
Medications
•
Progress Note
•
Diagnoses
•
Consult
Greenway
•
Procedure Codes (CPT,
HCPCS)
NextGen
•
Allergies
•
Date of Service
•
Chief Complaint
•
Problem List
•
HPI
Athenahealth
eClinicalworks
Epic
GE Healthcare
MedPlus
Vitera
Availity CareProfile
®
®
with EMR Integration
Integrated Clinical Documentation
Value Propositions
Cost / Quality / Compliance
Care Coordination
Revenue Cycle
Care Management
PCMH / ACO
Risk Management
HEDIS / 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
jzimmerman@availity.com