Availity Applauds Industry Commitment to Modernize Authorizations

Availity’s Intelligent Utilization Management delivers on health plans’ ambitious vision

JACKSONVILLE, Fla.--(BUSINESS WIRE)--Availity, the nation’s largest real-time health information network, celebrates the news that the country’s leading health insurers have pledged sweeping reforms to modernize the authorization process—committing to real-time decisions, standardized electronic workflows, and better transparency by 2027.

Availity is already delivering on this promise through its next-generation, FHIR-native Intelligent Utilization Management solution, which delivers authorization results in 90 seconds or less and is helping payers and providers transition from administrative bottlenecks to streamlined, clinically guided care. This market-leading innovation is enabled by Availity’s position as the industry’s largest dual-sided, real-time healthcare network—connecting over 3.4 million providers and directly connecting more than 95% of health plans.

“Our providers tell us that authorizations are the most frustrating part of their health plan relationship; not that they aren’t necessary, but that the utilization review process is unduly burdensome and complex,” said Availity CEO Russ Thomas. “Technology empowers us to reimagine authorization workflows more creatively, so that utilization review can serve the intended purpose in a way that makes care accessible, appropriate and available when you need it.”

Innovation Beyond Compliance

Under the health plans’ agreement, payers will standardize electronic submissions, deliver real-time answers for at least 80 percent of complete requests, provide clearer explanations of denials, and honor a 90-day continuation of previously approved care when members switch plans.

Availity’s is already delivering on this vision. The company’s Intelligent Utilization Management solution processed more than 1 million authorization requests in its first year of implementation; 80 percent were approved in under 90 seconds from submission, with most returned within 20 seconds.

Availity is honored to be the trusted partner to execute upon this vital commitment. As the chosen solution of many of the plans involved in this important movement. We support their efforts to exceed compliance mandates and deliver speed, transparency, accountability, and interoperability to a process long overdue for transformation.

Availity Intelligent Utilization Management solution is in use with plans covering more than 17 million lives. Five additional national and regional health plans, who combined have more than 45 million members, are contracted for deployment in 2025, demonstrating the national urgency to invest in technology that exceeds regulatory mandates and delivers a better authorization experience to providers and patients.

Availity Intelligent Utilization Management

Intelligent Utilization Management is a modular, AI-powered solution that streamlines prior authorization by reducing administrative burden, improving transparency, and accelerating access to medically necessary care.

Built with FHIR®-based APIs and designed to help health plans meet CMS interoperability mandates, the solution integrates directly into provider workflows to enable real-time or near real-time decisioning. Unlike traditional solutions, which depend on manual review or regressive predictive models, Availity’s system uses auditable AI and clinical data extraction to evaluate medical necessity at the point of care—ensuring faster, more transparent decisions and fewer delays. Determinations are returned in seconds, not days, transforming prior authorization from a pain point into a point of differentiation.

Availity’s proprietary clinical engine delivers transparent, criteria-based recommendations grounded in the health plan’s codified medical policy—an essential requirement for Medicare Advantage plans navigating evolving federal guidelines and complex regional variations. The solution was purpose-built to support CMS final rule and includes a modular, EMR-integrated workflow that dramatically simplifies submissions for providers.

The solution supports delegated vendor integration, customizable automation rules, and an ecosystem of best-in-class partners, giving health plans the flexibility to scale their UM programs while improving provider satisfaction and operational efficiency.

Innovation at Scale

Unlike delegated or single-sided platforms, Availity facilitates direct, bi-directional data exchange across both parties, eliminating intermediaries and reducing latency. This architecture supports synchronized workflows, allowing payers to configure medical policies and decision logic at scale while enabling providers to submit and resolve authorizations directly within their native EHR environments. For patients, this means faster access to care, fewer treatment delays, and a system that finally starts working the way it should: collaboratively, transparently, and in service of their health.

“Availity is providing a foundation for lasting change—combining cutting-edge technology with deep domain expertise and a collaborative, service-first approach,” said Matt Cunningham, Availity’s Executive Vice President of Product. “We give payers a path to go further: reduce unnecessary authorizations altogether, automate the ones that remain, and rebuild trust through transparency and traceability every step of the way. The health plans’ pledge and the CMS final rule align perfectly with that vision.”

About Availity

Availity empowers payers and providers to deliver transformative patient experiences by enabling the 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 that foster collaboration and shared value across the healthcare ecosystem. With connections to over 95% of payers, more than 3.4 million providers, and 1,700 trading partners, Availity provides mission-critical connectivity to drive the future of healthcare innovation. For more information, including an online demonstration, please visit www.availity.com or call 1.800.AVAILITY (282.4548). Follow us on LinkedIn and X.