Availity Automation: Eligibility, Claims, and Authorizations

Tell Champ what your team does in Availity and where the result belongs. Champ can check eligibility, follow up on claims, submit authorization requests, retrieve remittances, and update your EHR or billing system. Describe the workflow in plain English or share your SOP; Champ helps build and test it without requiring you to write browser scripts.

Availity automation means using software to complete recurring work in the portal. With Champ, the workflow can start in your appointment schedule or billing system, continue through Availity, and end with the result recorded where your team needs it. When the portal cannot provide a complete answer, Champ can call the payer and capture the response.

What can you automate in Availity?

Champ can be configured to handle the repeatable browser work your team performs in Availity. The available transactions depend on the payer and your account’s access. Availity’s portal documentation covers eligibility, authorizations, referrals, claims, remittances, and payer-specific resources.

The starting point is the result you need:

• Eligibility and benefits: coverage details recorded before the visit.
• Claim status: current payer responses and follow-up needs in your billing system.
• Prior authorization: requests submitted with supporting records and decisions tracked.
• Remittance retrieval: payment documents available to the billing team.
• Document handling: requested records uploaded and confirmations saved.

How can you automate Availity eligibility checks?

Champ can take a list of upcoming appointments, find the relevant patients in Availity, and retrieve the coverage and benefit details your team needs. It can capture active coverage, copays, deductibles, coinsurance, and service-specific information where the payer makes them available.

The result goes back into the patient record or intake system. Staff can see what was verified and which questions still need attention without opening every payer response themselves.

For example, you could describe the workflow this way:

Check eligibility in Availity for tomorrow’s appointments. Record the available coverage, copay, deductible, and coinsurance details in our EHR. Flag missing or conflicting information for review.

The workflow is configured and tested against your systems and requirements before use.

Our insurance eligibility verification guide explains how that work can extend across additional coverage sources.

Get claim status into your billing system

Champ can look up claims in Availity, capture the latest status, and record the response where your billing team works. When a payer requests existing supporting documents, the workflow can retrieve and upload them through the available submission path.

For example, Humana’s Availity resources describe claim-status review, requested medical-record submissions, and access to remittance documents. The steps available for another payer may differ.

A useful instruction is: “Check these outstanding claims, update our billing records, and identify any documents the payer is requesting.”

The outcome is a current record of what the payer has said and what needs to happen next. See our claims follow-up automation guide for the broader process.

Submit authorization requests and track responses

Authorization submission is one of the functions described in Regence’s Availity guidance. Champ can gather existing orders and supporting records, complete the available authorization forms, upload documents, and save the submission confirmation. It can then check for a response and record the payer’s decision in your system.

When the payer directs the request into another portal, the workflow can continue there through the browser. Clinical questions, attestations, and medical-necessity decisions remain with authorized staff.

The result is an authorization request that moves from preparation through submission and administrative follow-up. Our prior authorization automation guide covers that full journey.

Retrieve remittances and handle supporting documents

Champ can locate available remittance documents, download them, and save them to the appropriate billing record or document system. It can also collect existing records requested by a payer and upload them with the relevant claim or authorization.

These tasks are useful to automate because the information often needs to move between systems. Your team gets the document in the place where it will be used, with the relevant reference details preserved.

How do you automate Availity with Champ?

You start by describing the task and the outcome. Champ’s Builder Agent helps turn those instructions into a workflow, and the workflow is tested against the systems it will use.

The process is straightforward:

1. Describe the work. Explain what starts it, what needs to happen in Availity, and where the result belongs. An existing SOP can serve as the starting point.
2. Connect the required access. Champ uses the authorized Availity access and EHR, billing, or document systems needed for the task.
3. Test the result, then run it. Review representative examples and confirm that the workflow captures and updates the right information before using it repeatedly.

You do not need to write browser scripts to explain the work. For example, “Download the available remittance documents and attach them to the matching billing records” describes the business outcome directly.

Once one workflow is working, you can add another: eligibility before appointments, claim checks for unpaid balances, or authorization follow-up. Each workflow can use the systems your team already has.

Do you need an Availity API integration?

No custom Availity API integration is required for Champ’s browser-based approach. Champ can navigate the portal, enter information, read results, upload records, and download documents through the interface your team uses.

Availity also supports other transaction methods, including web forms and EDI connections, as described in its transaction submission documentation. Champ can combine available integrations with browser automation to complete the broader workflow.

That means the automation can include work before and after Availity: reading an appointment list, finding a chart document, updating an EHR, and recording the final result.

Can Champ connect Availity to your EHR?

Yes. Champ can work with any EHR or practice management system your team accesses through a browser. It can retrieve the information needed for the portal task and write the result back without requiring a prebuilt connector.

For an eligibility workflow, that could mean starting with the appointment schedule and ending with benefit details in the patient record. For claims, it could mean starting with outstanding balances and ending with updated payer responses in the billing system.

What happens when Availity does not provide the answer?

Champ can continue the workflow by phone when the portal response is incomplete. It can call the payer to clarify a claim status, confirm receipt of records, or ask about missing benefit information, then record the response in your system.

Your team can also review cases that require judgment or information the automation cannot obtain. Missing information stays visible rather than being filled in with an assumption.

Frequently asked questions

Can Champ automate a custom Availity workflow?

Yes. Champ can be configured for claim follow-up, authorization submissions and status checks, remittance retrieval, document uploads, and other repeatable Availity browser tasks. Describe the steps your team follows and the result you need, including work in other systems. The workflow is built and tested around your authorized access and the tools each payer makes available.

Do we need engineers to build an Availity automation?

You can describe the process in plain English or provide an SOP. Champ’s Builder Agent helps construct and test the workflow. Your team still provides the necessary access and confirms that the result matches how you work.

Can we automate a batch of patients or claims?

Yes. A workflow can repeat the required steps for a supplied list, recording the result for each item. Missing information and exceptions can be surfaced individually so staff know which records need attention.

Will every payer provide the same information?

No. Availity is a multi-payer portal, and available tools and responses vary. The workflow should capture what the payer actually provides and identify unanswered questions for follow-up.

Bring us your Availity workflow

Describe the task your team repeats and the result you want. Champ can help turn it into an automation that works across Availity, your EHR, documents, and phone calls.

Book a demo to see how your Availity workflow can run with Champ.