Payer-to-Payer Exchange Program Drives Interoperability
Availity, America’s largest real-time health information network, will showcase groundbreaking insights at HIMSS25 in Las Vegas, demonstrating best practices from their innovative Payer-to-Payer Data Exchange Cohort Program. Healthcare leaders can attend “Pioneering Bidirectional Data Exchange for Mandatory Compliance and Beyond” on Thursday, March 6, 2025, from 12:45-1:45 p.m. (PT) at Caesars Academy 415, or visit Availity at Meeting Place 10017 on the Exhibit Hall floor.
Launched in August 2023, Availity’s strategic partnership with select payers established the first connections within the Availity Connectivity Hub. This hub serves as a centralized connection point, dramatically accelerating interoperability and streamlining the Payer-to-Payer API data exchange process while eliminating the need for expensive, time-consuming point-to-point connections.
Meeting CMS Compliance Requirements Ahead of Deadline
The Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F) takes effect January 1, 2027, requiring affected payers to implement and maintain Payer-to-Payer APIs. These APIs must exchange clinical, claims, and authorization data when members switch health plans, following the U.S. Core Data for Interoperability (USCDI) version 1 content standard.
Availity’s proactive cohort program directly addresses challenges health plans face when establishing secure connections with other plans. By collaborating and testing well before the deadline, participants identify and resolve pitfalls in The Health Level Seven (HL7) International Da Vinci Payer Data Exchange (PDex) Implementation Guides—helping payers avoid implementation difficulties and ensure timely compliance.
AI-Powered Utilization Management Transforms Care Delivery
Availity’s Intelligent Utilization Management solution harnesses responsible AI to expedite delivery of appropriate care by reducing friction across utilization management interventions. The streamlined prior authorizations workflow not only simplifies submissions for providers but makes health plan determinations faster, easier, and more transparent.
The solution establishes a single submission pathway for providers, ensuring compliance with CMS-0057-F. At the determination stage, Availity’s proprietary AI clinical engine evaluates patient records against medical policy to determine medical necessity. Over 70% of cases receive determination recommendations immediately, allowing clinical staff to focus on complex cases. For pending cases, Availity enhances precision by presenting relevant information through intuitive decision-tree forms.
Expanding Healthcare Partner Ecosystem
Beyond building infrastructure for transforming utilization management, Availity continues expanding its robust partner ecosystem, ensuring clients access best-in-class solutions and content. This network includes industry leaders like MCG, Salesforce, Concert, WNS HealthHelp, and Xsolis, among others.
Rapid Recovery: Protecting Healthcare Operations
Recently, Availity announced Rapid Recovery, an innovative solution ensuring swift restoration of critical healthcare operations following catastrophic events. This groundbreaking model employs cutting-edge technology trusted by U.S. critical infrastructure sectors—including financial, communication, and defense industries—delivering unmatched resilience and recovery speed to healthcare organizations.
About Availity’s Healthcare Leadership
Availity empowers healthcare stakeholders to deliver transformative patient experiences through seamless exchange of clinical, administrative, and financial information. As the nation’s largest real-time health information network, Availity develops intelligent, automated, and interoperable solutions fostering collaboration across the healthcare ecosystem. With connections to over 95% of payers, more than 3.4 million providers, and over 2,000 trading partners, Availity provides the mission-critical connectivity driving healthcare innovation.
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