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AAHAM – Summer Session

AAHAM – Summer Session. Agenda. Availity Overview Administrative Solutions Financial Solutions Clinical Solutions Summary. Availity Overview. The Availity Perspective.

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AAHAM – Summer Session

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  1. AAHAM – Summer Session

  2. Agenda Availity Overview Administrative Solutions Financial Solutions Clinical Solutions Summary

  3. Availity Overview

  4. The Availity Perspective It is Availity's mission to optimize information exchange between multiple health care stakeholders through a single, secure network. Our goals are your goals: Reduce administrative costs Improve relationships between payers, providers, employers, patients Use technology to improve workflow Improve the quality, safety, and affordability of health care

  5. Who is Availity? More than 700 million annual transactions $ >150 Direct Payers >1,150 Indirect Payers >65,000 Physician Offices Availity® Health Information Network Business Solutions Clinical Solutions >400 Vendor Partners - Clearinghouses - Practice Management Systems - Hospital Information Systems (HIS) - Electronic Medical Record (EMR) Systems >1,000 Hospitals >455,000 Employers >70,000,000 Members

  6. Where Does Availity do Business? Central Region (OH, KY, IN, MO, WI) Live in January 2010 WA ME ND MT MN VT NH OR Northeast Region (CT, ME, NH) Q2 2011 NY WI MA SD ID CT RI MI WY NJ PA IA OH NE DE MD New York Q3/Q4 2011 IN NV IL WV VA UT CO CA MO KS KY CA Virginia Live in May 2010 NC TN OK SC AR AZ Georgia January 2011 NM GA AL MS West Region (CA, CO, NV) November 2010 LA TX FL • Availity Deployed • States with Availity Activity • 2011 WellPoint States AK HI

  7. How Availity Fits

  8. Improving Outcomes & Reducing Costs Administrative • Supporting National HIT Objectives • Security & Privacy • Compliance – HIPAA, CORE, EHNAC • Interoperability – seamless integration with multiple systems and stakeholders • Meaningful Use – leverage widely available, consistent administrative data • Deliver Quality – real-time access to actionable, relevant patient information at the point of care • Eliminate Cost – identify fraud through medication history access; save time by improving access to important information • Improve Outcomes – reduce avoidable adverse drug events by providing alerts at the point of care • Eligibility & Benefits, Claim Status, Claims, Referrals & Authorizations • Card Swipe Financial • Patient Responsibility Estimation • Payment Collection Clinical • Health Record Information • Electronic Prescribing

  9. Health Plan Transactions HIPAA compliant transactions with multiple health plans Eligibility and Benefits Authorizations and Referrals Claims Claim Status Electronic Remittance Web and integrated connections Information is shared in real-time Edits ensure data accuracy Helps improve accounts receivable Offered to providers at no charge Available nationwide

  10. File Transmission Options Log on to the Availity portal to submit batch files and review, retrieve, download, and import response files and reports. Availity Secure Web Portal Exchange batch files without logging in to the Availity portal. Secure File Transfer Protocol (SFTP) Conduct transactions through your existing system in batch or real-time. Direct Integration

  11. Value Added Services

  12. CareCost EstimatorSM Helps determine a patient’s financial responsibility at the point of care Based on member benefits, deductibles, provider contractual allowances, and benefit maximum accumulators at the time of inquiry Collect the patient’s responsibility at the time of treatment, reducing accounts receivable Offered to providers at no charge CareCalc® is BCBSF’s branded product

  13. CareCost EstimatorSM Benefits Enables providers to collect the patient’s responsibility at the time of treatment, improving accounts receivable CareCost Estimator is available when providers need it Prior to the service as an estimate of patient responsibility At the point of service when the patient checks out When a patient contacts their provider to question a bill Responses are provided real-time, based on information at the time of the inquiry

  14. CareCollect® Process credit and debit transactions Turn paper checks into electronic transactions Set up recurring payments for repeat patients or installment payment plans Void and credit payments Perform end-of-day settlements Run customized reports Can replace existing point of sale device

  15. CareProfile • Electronic Health Profile that draws information from claims submitted to multiple health plans. • Availity CareProfile provides an up-to-the minute, consolidated view of patients’ health care history across multiple providers. CareProfile® Still relying on handwritten forms to get medical histories? Aside from the time it eats up, this process can leave out important clinical information. CareProfile is an electronic health record that draws information from claims submitted to multiple health plans. You get an up-top-the-minute, consolidated view of a patient’s care across providers, including diagnoses, prescriptions, and lab tests. You can improve patient safety and relationships and avoid duplicate services.

  16. CarePrescribe® Value-Add Services • Electronic Prescribing Solution Availity CarePrescribe is an e-prescribing solution that provides real-time access to medication history, eligibility, and formulary information via a handheld device or the Availity portal. Rx CarePrescribe® Using a convenient handheld device or secure web site on Availity’s network, you can quickly and easily submit prescriptions electronically. You can even view therapeutic equivalents, drug interactions, and lower cost alternatives.

  17. Future Administrative Services* Claim Attachments Support solicited delivery of claim electronic attachments Reporting Enhancements Enhance ad-hoc reports Availity Remit Manager Retrieve and present ERA data online in a standardized, human-readable format Search, view and drill down to a claim service level Access up to seven years of historical claims information Revenue Cycle Management realmed *Priorities and timelines may change.

  18. Summary

  19. Workflow simplification and cost savings Administrative, clinical, and financial services available at no charge Single secure connection with multiple health care constituents Practice Management System (PMS) and Hospital Information System (HIS) integration in both real-time and batch Improved information accuracy Faster claims submission Improved patient satisfaction HIPAA/standards compliance Availity Value

  20. Questions

  21. Contact P.O. Box 550857 Jacksonville, FL 32255-0857 904.470.4900 Bill Thomas Channel Partner Sales Executive 904-470-4067 wthomas@availity.com 1.800.AVAILITY (282.4548) www.availity.com

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