Product Overview: Availity AuthAI
Availity AuthAI is a cutting-edge solution designed to revolutionize the prior authorization process in healthcare, leveraging advanced technologies such as Artificial Intelligence (AI), Natural Language Processing (NLP), and clinical data integration.
What Availity AuthAI Does
Availity AuthAI is part of Availity’s comprehensive healthcare solutions, aimed at eliminating prior authorization review bottlenecks and streamlining the authorization process for both providers and payers. This system is integrated within Availity’s existing workflows, including Availity Essentials and Essentials Pro, to provide real-time updates and efficient authorization management.
Key Features and Functionality
1. Real-Time Decisions and Updates
Availity AuthAI enables real-time status updates and authorization administration, allowing providers to manage authorizations seamlessly within their existing Availity workflows. This results in significantly reduced authorization review times, as demonstrated by successful implementations where median response and resolution times are as low as 27 seconds.
2. AI and NLP Integration
Unlike traditional solutions that rely on statistical modeling, Availity AuthAI harnesses the power of AI and NLP to analyze clinical data. This approach ensures speed and accuracy in medical necessity reviews, providing recommendations rather than absolute decisions to maintain transparency and ethical standards.
3. Automated Authorization Process
The system can automatically authorize over 40 common procedures and manage a large volume of cases daily, with up to 78% of authorizations resolved without human intervention. This automation significantly reduces the administrative burden on providers and payers.
4. Transparency and Validation
Availity AuthAI undergoes thorough validation by health plan clinical staff during implementation and continuous monitoring during delivery. The system presents AI-suggested answers to attestation questions, ensuring accurate representation of the provider’s request and maintaining an ethical stance for accuracy.
5. Integration with Existing Workflows
The solution is seamlessly integrated into Availity’s multi-payer platform, allowing providers to submit prior authorization requests, clinical information, and receive status updates without the need for phone calls or faxes. This integration also provides instant access to all submission records from any location at any time.
6. Scalability and Efficiency
Availity AuthAI is designed to handle a high volume of transactions efficiently. It processes thousands of cases daily, making it a scalable solution for large healthcare organizations. This efficiency translates into impressive real-world outcomes, such as significantly reduced authorization review times and improved care coordination.
7. Collaboration and Standards Compliance
Availity collaborates with industry organizations like Health Level Seven International (HL7) and the Workgroup for Electronic Data Interchange (WEDI) to advance standards in data usability and exchange. This ensures that Availity AuthAI adheres to industry standards and best practices, enhancing its reliability and effectiveness.
Conclusion
In summary, Availity AuthAI is a powerful tool that leverages AI, NLP, and clinical data to streamline the prior authorization process, reduce administrative burdens, and enhance the overall efficiency and accuracy of healthcare transactions. Its integration with Availity’s existing platforms and adherence to industry standards make it a robust solution for both providers and payers.