eviCore healthcare offers proven, diversified medical benefit management solutions that help clients reduce costs while increasing quality of care for their members. The company provides these solutions to managed care organizations and risk-bearing provider organizations serving commercial, Medicare and Medicaid populations. Powered by a team of specialized medical professional resources, extensive evidence-based guidelines and advanced technologies, the company supports clients by ensuring the right evidence-based care is delivered at the right time to the right patient at the right site of care.

Availity, L.L.C. provides Internet-based health information exchange services. It optimizes the flow of information between health care providers, health plans, and other health care stakeholders through an Internet-based exchange. The company offers commercial and government health plan transactions; and CareRead, which swipes patients' magnetic stripe-enabled member ID cards through a three track card reader connected to the computer to automatically populate the fields on Web transaction pages. It also provides CareProfile, which allows to access electronic health records; patient communication, which connects physicians and patients online, and supports patient-initiated appointment and referral requests; and CarePrescribe, an electronic prescribing solution that provides access to up-to-date patient specific medication history and coverage, therapeutic equivalent and lower cost alternative options, and real-time drug interaction checks. In addition, the company offers CareCost Estimator, which determines a patient's financial responsibility in real-time at the point of care; and CareCollect, which collects patient's responsibility through a card swipe, including combination member ID cards for high deductible plans, debit cards, and credit cards. It serves various health care providers, including physician offices, hospitals, integrated delivery networks, pharmacies, laboratories, imaging centers, and other ancillary providers. Availity, L.L.C. was founded in 2001 and is based in Jacksonville, Florida.

eviCore intelliPath® is eviCore’s electronic prior authorization solution housing a suite of capabilities that simplify and automate the prior authorization process. These capabilities include connectivity, real-time decisions, case validation, and simplified clinical surveys.

eviCore intelliPath® is deployed by provider organizations to automate and simplify submitting and tracking requests for prior authorization. eviCore intelliPath® streamlines operations within a single easy-to-use application that integrates with major electronic health record (EHR) vendors. Provider costs are reduced and decisions are communicated in real time, reducing delays.

Administrative Cost Savings

eviCore’s medical benefits management solutions are proven to reduce unnecessary–and potentially harmful–tests and procedures. But securing prior authorization can impose a high burden on provider organizations; for example, dedicated administrative staff are hired to request and track cases, and clinicians typically must allocate time to provide details on the patient’s medical diagnosis.

In place of implementing an abundance of tools, multiple health plan portals, and time-consuming manual interactions, eviCore intelliPath® simplifies and streamlines prior authorization operations with a single, integrated application. eviCore intelliPath® leverages the substantial investment in EMRs on the part of provider networks. It automatically incorporates case details from the patient’s chart and fits seamlessly into clinical and revenue cycle workflows.

Clinical Efficiency

Further, eviCore intelliPath® integrates with eviCore’s utilization management system (and those of other UM providers). This speeds communication of critical information (e.g., automated approval, no prior authorization required, or additional clinical information is needed for a decision to be made). With the approval or denial in hand, patients can be scheduled or alternative tests or procedures ordered in a timely fashion.

Benefits for Patients, Providers, and Health Plans

• Lower costs for healthcare-delivery organizations
• Reduced frustration and more transparency for patients and clinicians
• Better network relationships for health plans

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• 2 Million providers on platform
• 200+ B2B Partners
• 45% of all covered lives carried exclusively through Availity
• 1.2 Million Daily Logins
• 100% of US Health Plans on the platform
• 112 Million covered lives carried exclusively through Availity