Availity is a real-time health information network that creates a transparent exchange of information among health plans, providers, and technology partners. It develops solutions for healthcare data acquisition, standardization, transparency, and automation.
Now the company is tackling a new problem: healthcare revenue cycle management (RCM).
"Modern revenue cycle management is the heart of every practice, hospital, and health system. When it’s healthy, it feeds every corner of the organization—from the front desk and the executive office to every function in between. When it’s unhealthy, the result is chronic operational inefficiencies, increased financial risk, burned-out staff, and frustrated patients," Russ Thomas, CEO of Availity, told VatorNews.
"Patient care is the focal point of healthcare, but RCM forms its foundational business strategy. For healthcare executives, focusing on operational aspects such as coding accuracy and technological efficacy in payment systems is essential. Optimizing these components is not just a task—it’s a strategic imperative. Getting the revenue cycle right allows more people and resources to be deployed in service of patient care."
On Monday, Availity announced a new strategic partnership with Janus, a revenue cycle automation and operational intelligence platform, in which the two companies will seek to modernize the standards of healthcare RCM.
Founded in 2020, the Janus revenue cycle platform starts by understanding the current state of revenue cycle operations, after which it identifies areas for efficiency, and where automation can help the revenue cycle team. Through the use of Janus' technology, revenue cycle teams have been able to generate as high as 2% increased net revenue while reducing cost to collect as much as 35%.
For customers leveraging Availity Essentials Pro, the company's revenue cycle management platform, Janus provides a pathway to enhanced efficiencies through automation and process mining capabilities, by giving them insights and recommendations, optimizing workflows and streamlining processes.
"Janus has a trading partner relationship with Availity. Their focus on delivering efficiencies and removing waste from administrative functions is a perfect complement to our vision as the company and the solutions we bring to market," said Thomas
"It’s a complementary relationship built on the idea of enabling large provider organizations to drive administrative efficiencies. Identifying areas where workflows can be improved without requiring complex reengineering processes is where the Availity and Janus relationship comes in. Janus applies AI to analyze the rich content that comes through Availity to help revenue cycle professionals take the right actions, at the right time in the workflow."
Availity's solution, Availity AuthAI, helps its provider and health plan customers overcome the common barriers to ensuring timely care delivery, resource allocation, and patient satisfaction. On the provider side, the company has also tapped into AI with the launch this year of its Predictive Editing tool for Availity Essentials Pro, its end-to-end revenue cycle management platform. Predictive Editing uses an AI algorithm to analyze claims data across a broad network of provider organizations, as well as policies specific to individual health plans.
The company also offers Availity Fusion, its clinical data refinement engine, which was rebranded after it acquired the clinical data and interoperability company Diameter Health in August 2022; it automates the process of upcycling clinical data in real-time.
"Availity Fusion has become a cornerstone of our strategy to empower providers and health plans to benefit from actionable, real-time, and precise data insights to reduce administrative inefficiencies, maximize revenue potential, and drive quality of care improvements for patients on one scalable platform," said Thomas.
Currently, Availity supports 2.9 million active providers and 15,000 vendor partners, with a nationwide healthcare network and optimized revenue cycle workflows. The company also processes 11 billion transactions annually.
As for how the two companies will work together going forward, Janus has a referral relationship with Availity, meaning that if Availity is talking with a hospital or health system that is focused on improving the efficiencies within the EHR and their workforce, that could be a good opportunity for them to use the Janus solutions in concert with Availity Essentials Pro’s end-to-end revenue cycle management platform.
While Availity provides connectivity to health plans across the country, ensuring that the information returned to the providers’ EHR is high quality, and enabling providers to complete their administrative tasks without leaving their established workflows, Janus complements those capabilities by driving more efficiencies within the EHR.
This relationship is about super-charging opportunities to identify ever more efficiencies in the revenue cycle management process, said Thomas.
"Together, our solutions seamlessly capture work being done across systems, applications, and teams—identifying bottlenecks and surfacing process improvement and automation opportunities. The result is empowering providers to submit cleaner claims, increase staff efficiency, and see faster reimbursement," he said.
"Janus’ solutions deliver efficiencies to the provider’s EHR and Availity brings connectivity to health plans in addition to the benefits of our end-to-end revenue cycle platform."
(Image source: janus-ai.com)
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