The Market Standard for Revenue Cycle Management

Availity Revenue Cycle Management delivers full-cycle revenue cycle capabilities, streamlining pre-service, post-service and post-adjudication workflows.

As healthcare operations become more complex, hospitals and medical practices need advanced revenue cycle management solutions that automate workflows, reduce claim denials, and accelerate reimbursements—without increasing administrative burdens or disrupting existing systems.

Availity Revenue Cycle Management (RCM) is a full-cycle revenue cycle solution that helps provider organizations streamline revenue cycle operations throughout all three phases: pre-service, post-service, and post-adjudication.

Why Availity Revenue Cycle Management?

Secure

Leverage Availity’s secure by design environment to gain peace of mind on your organization’s ability to recover rapidly from cyber-attacks.

Direct

Become part of Availity’s dual-sided network and reach the most nationwide payers directly, reducing transaction delays.

Efficient

Automate tasks that previously required manual intervention and prevent denials before they happen.

Seamless

Create a curated, end-to-end experience by seamlessly integrating new solutions into RCM workflows, eliminating siloed experiences.

Pre-Service Automation Prevents Claim Denials Before They Happen

Strong pre-service workflows help healthcare organizations prevent claim denials by ensuring the right information is captured upfront. Availity RCM helps providers streamline insurance eligibility verification, ensure accurate coverage detection, and secure prior authorization directly within their EHR. Our automated pre-service tools include:

Patient Access

Incomplete or inaccurate patient information slows down the delivery of care and increases the chance of denials. Availity RCM helps providers get fast, accurate and near real-time patient coverage without leaving the EHR.

Eligibility

Providers want to receive the most up-to-date eligibility information directly in their workflow. With access to Availity’s nationwide, dual-sided network, providers can receive real-time eligibility and benefit information directly in their workflow.

Authorizations

Providers spend too much time manually managing prior authorizations—from calling a payer to find out if an authorization is required, submitting the authorization via fax, or calling the payer to check the status. Availity RCM connects directly to payers, helping automate the submission process to get care decisions faster.

Complete Capabilities

Patient Access: Patient Financial Clearance, Financial Assistance Scoring, Address Verification, Medicaid Redetermination, Patient Estimates, Propensity to Pay and Credit Scores.
Eligibility: Coverage Locator, Advanced Real-Time Eligibility, 270/271 Batch Eligibility, Self-Pay Eligibility Check, Interactive Eligibility (DDE), Pre-Claim Eligibility, Patient Financial Profile.
Authorizations: Provider Authorizations, 278 Notice of Submission, EDI Enrollment.

Post-Service Claim Management Powered by AI and Automation

Manual claim management processes slow down reimbursements, increase denial rates, and create administrative burdens for providers. Availity RCM’s AI-powered automation and predictive claim editing capabilities streamline electronic claim processing, reduce errors, and enhance financial insights—helping improve revenue cycle performance. Our advanced post-service solutions include:

Claims Processing

Availity RCM allows providers to electronically submit many types of claims, including primary and secondary paper claims.

Claims Management and Editing

Because payer rules change often, claim editing can be a time-consuming and costly process. Availity RCM’s AI-driven predictive editing analyzes claims before they are sent to the payer, allowing providers to manage, correct and submit cleaner claims to reduce back-end denials and get paid faster.

Claim Status

Providers spend too much time calling payers to find out whether a claim has been accepted, denied, or paid. Availity RCM helps providers get claim status and history in real-time and in one place.

Complete Capabilities

Claims Processing: Claim Electronic Attachments, Automated Claim Status, Medicare Enhanced Claim Status, Real-Time Claims Editing, Worker’s Compensation Claims, Claims Editing, Batch Claims (837), Interactive Claims Submission (DDE).
Claims Management and Editing: ACE Claim Edit and Rule Creation, Predictive Editing, CDM Revenue, Integrity.
Claim Status: Advanced Claim Status, Real-Time Claims Status, Claim DTP, Auto Status, Claim Errors (276/277/CRD).

Post-Adjudication Tools for Smarter Workflows to Get Paid Faster

Denied claims create administrative backlogs, lost revenue, and delays in provider payments. Availity’s RCM features denial management tools to identify claim denial patterns, streamline appeals workflows, and accelerate revenue recovery. Our post-adjudication solutions include:

Remit Processing

Providers often manually review and process remits, which drives increased administrative burden and errors. Availity RCM automates delivery of remittance files, and manages missing remits, and matches remits back to the claim in real-time.

Denial Management and Appeals

High denial volumes overwhelm revenue cycle teams and delay care or reduce reimbursement. Availity RCM automates the creation and management of claim edits, and leverages AI to identify potential claim denials before they go to payers.

Patient Payments

Billing teams spend significant time chasing unpaid bills. Availity RCM simplifies the patient payment process with automated workflows that streamline the entire process—from statement delivery to payment posting.

Analytics and Business Intelligence

RCM leaders often lack the visibility into the underlying data of their operations and are left to make decisions by instinct or gut feel. Availity RCM helps reduce time spent gathering data, enhance decision-making with data-driven insights and filter data against RCM goals with both executive and user-level analytics.

Complete Capabilities

Remit Processing: Electronic Remittance Delivery and Claim Matching, Paper EOB to 835 Remittance Advice Transformation, Remittance Auto-Posting (835), Lockbox, EFT Reconciliation, Remit Replication.
Denial Management and Appeals: Denial Prevention and Management Module, Appeals Form API, Electronic Attachments.
Patient Payments: Patient Statements, PersonaPay, eStatements, ePayments.
Analytics and Business Intelligence: Cloud-Based Analytics and Dashboard Reporting, Rev Cycle Assistant.