List of Availity EDI Clearinghouse Customers
Jacksonville, 32256, FL,
United States
Since 2010, our global team of researchers has been studying Availity EDI Clearinghouse customers around the world, aggregating massive amounts of data points that form the basis of our forecast assumptions and perhaps the rise and fall of certain vendors and their products on a quarterly basis.
Each quarter our research team identifies companies that have purchased Availity EDI Clearinghouse for Electronic Data Interchange (EDI) from public (Press Releases, Customer References, Testimonials, Case Studies and Success Stories) and proprietary sources, including the customer size, industry, location, implementation status, partner involvement, LOB Key Stakeholders and related IT decision-makers contact details.
Companies using Availity EDI Clearinghouse for Electronic Data Interchange (EDI) include: Humana, a United States based Insurance organisation with 65680 employees and revenues of $117.76 billion, Blue Cross Blue Shield of Minnesota, a United States based Insurance organisation with 3900 employees and revenues of $15.30 billion, Regence BlueShield, a United States based Insurance organisation with 3500 employees and revenues of $2.60 billion and many others.
Contact us if you need a completed and verified list of companies using Availity EDI Clearinghouse, including the breakdown by industry (21 Verticals), Geography (Region, Country, State, City), Company Size (Revenue, Employees, Asset) and related IT Decision Makers, Key Stakeholders, business and technology executives responsible for the software purchases.
The Availity EDI Clearinghouse customer wins are being incorporated in our Enterprise Applications Buyer Insight and Technographics Customer Database which has over 100 data fields that detail company usage of software systems and their digital transformation initiatives. Apps Run The World wants to become your No. 1 technographic data source!
Apply Filters For Customers
| Logo | Customer | Industry | Empl. | Revenue | Country | Vendor | Application | Category | When | SI | Insight |
|---|---|---|---|---|---|---|---|---|---|---|---|
 |
Blue Cross Blue Shield of Minnesota | Insurance | 3900 | $15.3B | United States | Availity | Availity EDI Clearinghouse | Electronic Data Interchange (EDI) | 2022 | n/a |
In 2022, Blue Cross and Blue Shield of Minnesota implemented Availity EDI Clearinghouse. The rollout used Availity’s 'Is Auth Required' solution via the Availity Essentials platform to automate authorization determination within Electronic Data Interchange (EDI) flows that support prior authorization workflows in the United States.
Configuration centered on embedding automated authorization determination into authorization intake workflows, using Availity Essentials to evaluate whether an authorization was required at point of submission. The implementation leveraged Availity’s clearinghouse and network connectivity to exchange authorization related EDI transactions and to orchestrate automated responses to provider inquiries, reducing manual verification steps.
Operational coverage emphasized provider facing intake and utilization management processes, directly impacting provider call center volume and provider network communications. The technical architecture inferred a cloud based clearinghouse mediation layer that routed authorization related transactions between provider systems and Blue Cross and Blue Shield of Minnesota, and applied decisioning logic to determine next steps in the workflow.
Governance and process changes embedded the authorization decision logic into existing intake and escalation workflows to reduce manual routing. Outcomes documented include a reduction in provider authorization related calls from about 200 per month to about 50 per month, recognition in KLAS Points of Light published May 2023, and reported multi year savings.
|
 |
Humana | Insurance | 65680 | $117.8B | United States | Availity | Availity EDI Clearinghouse | Electronic Data Interchange (EDI) | 2023 | n/a |
In 2023, Humana implemented Availity EDI Clearinghouse to operationalize end to end electronic prior authorization for utilization management. The deployment targeted utilization management and prior authorization workflows in the United States and used Electronic Data Interchange (EDI) capabilities to connect payers and EHRs through a clearinghouse model.
The implementation combined Da Vinci FHIR APIs to initiate and manage prior authorization requests from EHR systems with Availity’s network translation and routing that converts FHIR messages into X12 278 transactions. Availity EDI Clearinghouse functioned as the translation and routing layer, handling message normalization, X12 278 provisioning, and automated routing to payer adjudication engines.
Integrations were explicit with athenahealth for EHR connectivity and with payer processing flows via Availity’s network, creating an end to end pathway between clinician systems and Humana’s utilization management processing. Operational coverage focused on utilization management and prior authorization business functions, consolidating request intake, eligibility validation, and administrative routing through the Availity network.
Governance and evaluation were conducted during an Oct to Dec 2023 assessment, which reported approximately 70 percent auto approvals and an average 26 hour turnaround for the implemented workflow. The project description identifies Availity’s network translation to X12 278 as the clearinghouse Electronic Data Interchange (EDI) component that enabled payer and EHR interoperability for prior authorizations.
|
 |
Regence BlueShield | Insurance | 3500 | $2.6B | United States | Availity | Availity EDI Clearinghouse | Electronic Data Interchange (EDI) | 2020 | n/a |
In 2020, Regence BlueShield implemented Availity EDI Clearinghouse to strengthen pre-service eligibility workflows, using Electronic Data Interchange (EDI) to deliver richer benefit data to network providers. The effort targeted dental provider interactions in the United States, centering on eligibility and benefits verification ahead of service authorization.
The deployment configured Availity EDI Clearinghouse to return procedure-code-level eligibility and benefits using ANSI X12 271 transactions, leveraging Availity’s eligibility and EDI capabilities to surface detailed benefit fields. The implementation included an enhanced provider-facing user interface that presented procedure-level benefit detail and streamlined eligibility query responses.
Operationally, the solution integrated transaction orchestration with the provider portal and provider-facing workflows, ensuring 271 responses were available in the front-end eligibility UI used by dental offices. Coverage for this implementation was limited to United States pre-service eligibility use cases and focused on dental provider interactions rather than claims adjudication.
Governance centered on updating pre-service verification processes and provider communication workflows to consume richer 271 responses, with the enhanced UI launched in October 2020. The implementation explicitly reduced dental provider call volume and resulted in approximately $75,000 in call-volume savings within eight months, while improving provider confidence in eligibility and benefits responses.
|
Buyer Intent: Companies Evaluating Availity EDI Clearinghouse
Discover Software Buyers actively Evaluating Enterprise Applications
| Logo | Company | Industry | Employees | Revenue | Country | Evaluated | ||
|---|---|---|---|---|---|---|---|---|
| No data found | ||||||||