Availity Reviews: Features, Pricing, Pros, Cons & Best Alternative

Quick Summary

Availity serves as a central hub for administrative and clinical data exchange between healthcare providers and insurance payers, helping streamline workflows, reduce manual processes, and minimize errors across multiple payer networks.

This review examines Availity’s core features, pricing structure, and real-world user feedback to help healthcare providers determine if the platform meets their verification and revenue cycle needs. We also explore alternative solutions, including VerifyTreatment, for providers who require more specialized insurance verification capabilities.

Why listen to us?

VerifyTreatment was built by healthcare providers who experienced firsthand the operational challenges of insurance verification—denied claims, verification delays, and revenue loss from coverage gaps. Our team helps facilities ensure proper insurance coverage before admission, reducing unrecoverable losses and streamlining verification workflows.

“Great Product, Ease of Use, Added Efficiency for Our Team. Automating and bringing in health insurance verifications to our instance was a game changer. We have instant verifications for all of our prospects, as well as automated verifications for our clients on a weekly basis.”

TEANA ELLERBE Director of Billing

We understand the pain points because we’ve lived them. That’s why this review examines Availity honestly—acknowledging where it excels and where providers might need more specialized solutions. Our goal is to help you make an informed decision based on your facility’s actual verification needs.

What is Availity?

Availity is a health information network that facilitates data exchange between healthcare providers, health plans, and technology partners. The platform centralizes administrative functions like eligibility verification, claims submission, and prior authorizations across multiple insurance payers.

As the nation’s largest real-time health information network, Availity processes 13 billion clinical, administrative, and financial transactions annually. The platform addresses a fundamental challenge in healthcare: the need for providers to communicate with dozens of different insurance companies through a single, standardized interface.

Who Availity is Best (and Worst) For

Availity is designed for:

• Payers: Health insurance companies and government programs that need to exchange data with providers at scale
• Providers: Physicians, hospitals, clinics, and healthcare facilities that interact with multiple insurance payers
• Healthcare IT Companies: Technology vendors that integrate with Availity’s network to exchange healthcare data

Availity is not ideal for:

• Patients: This is a B2B platform for provider-payer transactions, not a patient portal for personal health records
• Providers needing specialized verification: Facilities requiring detailed, service-level coverage verification before admission may find the platform’s benefit checks too general
• Payers outside the network: If a health plan isn’t connected to Availity’s network, you cannot use the platform for that insurer

Key Features

For Providers:

• Revenue Cycle Management: Automates workflows from patient check-in through payment posting, reducing manual data entry and administrative overhead.
• Eligibility & Coverage: Real-time insurance verification across multiple payers through a single portal. Providers can check benefits, identify covered services, and estimate patient costs without logging into separate payer systems.
• Authorizations: Centralized authorization management for multiple payers. Providers submit and track prior authorization requests in one location, reducing phone calls and fax submissions.
• Claims & Claim Status: Web-based claims submission for multiple claim types with real-time status tracking. The platform reduces paper-based processes and provides visibility into claim adjudication.

For Payers:

• Provider Engagement: Allows payers to deliver information to providers through their existing workflows, reducing support calls and portal friction.
• Provider Directories: Enables providers to update demographic and practice information across multiple payers simultaneously, improving data accuracy and reducing administrative costs.
• Digital Correspondence: Centralizes provider communications in a digital hub, eliminating print and mail costs while providing delivery confirmation.
• Payment Accuracy: Identifies claim errors before submission and returns issues to providers for correction, reducing denials and improving first-pass acceptance rates.

For HITs:

• Healthcare Connectivity: Provides standardized APIs and EDI connections for HIT systems to exchange administrative and clinical data with payers securely.

Pricing

Availity does not publish transparent pricing on its website. To access detailed cost information, providers must create an account or contact the sales team directly. This lack of pricing transparency makes it difficult to budget for the platform or compare costs against alternatives.

The most recently published pricing tiers (last updated in 2023) include:

• Availity Essentials: Free
• Availity Essentials Plus: Starts at $25/month
• Availity EDI Clearinghouse: Starts at $35/month

Given that this pricing is now three years old and Availity has not published updated rates, providers should contact Availity directly for current pricing. The free tier makes the platform accessible to small practices, but the lack of transparency around paid features and their costs remains a barrier to informed decision-making.

Availity Limitations

Difficulty Finding Policy and Claims Information

Users report that claims and payment information cannot always be located within the system, requiring them to contact payers directly or use alternative methods. Some providers note that access to out-of-state Blue Cross Blue Shield claims, previously available, has been restricted. Additionally, insurance card details and policy information don’t consistently work across all insurance companies, leading to incomplete verification data.

Poor Platform Usability

Navigation remains a consistent complaint among users. Providers describe the interface as difficult to navigate, with multiple reviewers explicitly stating the platform is “not user-friendly.” Basic tasks that should be straightforward often require workarounds or multiple steps, suggesting the platform may not have been designed with actual end-user workflows in mind.

Lack of Service-Level Verification Clarity

Availity advertises comprehensive benefit verification, but users report that the system provides vague coverage information. The platform often doesn’t clearly indicate whether specific services or procedure codes are covered, forcing providers to make additional calls to payers for confirmation. This gap between advertised capabilities and actual functionality creates frustration, particularly for providers who need detailed verification before admitting patients.

VerifyTreatment: An Alternative for Specialized Verification Needs

For providers who require more detailed, service-level insurance verification—particularly in behavioral health and specialty care—VerifyTreatment offers a platform built specifically for pre-admission verification workflows.

VerifyTreatment focuses on behavioral health facilities, skilled nursing centers, durable medical equipment (DME) providers, billing companies, and revenue cycle management firms. The platform is designed to provide the depth of coverage information and verification clarity that general-purpose networks often lack.

Key Features

• Eligibility & Coverage: Real-time benefits verification with detailed financial intelligence beyond basic eligibility confirmation.
• Payer Alerts: Captures institutional knowledge about payer quirks and requirements, automatically surfacing relevant information during verification to prevent common errors.
• Batch Verification: Re-verify hundreds or thousands of patients simultaneously to catch policy changes, prevent surprise denials, and maintain current coverage information.
• Custom Exports: Generate PDF verification reports with your facility’s branding for consistent documentation across your organization. 
• CRM Integrations: Native Salesforce integration that embeds verification directly into existing workflows without requiring staff to switch between systems.

Availity vs VerifyTreatment (Comparison Table)

Here’s a quick summary of how each platform compares on usability, reliability, and feature clarity:

Why VerifyTreatment Works for Specialized Verification

Built by Providers for Providers

VerifyTreatment was developed by healthcare professionals who experienced the daily challenges of admissions, billing, and reimbursement in behavioral health. The platform addresses real operational problems: incomplete verification leading to denials, time-consuming manual processes, and lack of service-level coverage clarity. The platform includes HIPAA-compliant team messaging, allowing verification teams to communicate securely without leaving the system.

Transparent Pricing Structure

Unlike platforms where essential features are locked behind premium tiers, VerifyTreatment’s pricing plans provide meaningful functionality at each level. Providers receive verification capabilities that align with their tier’s cost, rather than paying for access to features that should be standard for effective insurance verification.

Reduced Verification Time

The batch verification feature allows teams to verify multiple patients simultaneously with supported payers, reducing the time spent on repetitive, individual verification tasks. This efficiency gain allows staff to focus more time on patient care and complex cases that require individual attention.

Fewer Admission Denials

By providing clearer visibility into coverage details and service-level benefits, VerifyTreatment helps providers make informed admission decisions. When verification is more complete upfront, facilities avoid the operational and financial disruption of post-admission denials and can ensure patients have confirmed coverage before beginning treatment.

Final Verdict: Should You Choose Availity?

Availity remains a widely used platform for provider-payer communication, offering a centralized hub for eligibility checks, claims submission, authorizations, and digital correspondence across multiple health plans. For providers who need basic eligibility verification and claims management across a broad payer network, Availity serves its purpose effectively.

However, as verification requirements grow more complex—particularly in behavioral health and specialized care settings—Availity’s limitations become more apparent. The platform’s lack of service-level coverage details, inconsistent data availability across payers, and navigation challenges can create operational friction for facilities that need detailed verification before admission.

For organizations operating within Availity’s established payer network and requiring only basic eligibility checks, the platform remains a viable option. But for providers that need detailed, service-level insurance verification to prevent denials and manage high patient volumes, a more specialized solution may be necessary.

VerifyTreatment addresses these gaps by focusing exclusively on insurance verification. Its payer alerts, batch verification capabilities, workflow integrations, and transparent pricing help teams make informed admission decisions, protect revenue, and reduce operational friction. For organizations where verification accuracy directly impacts financial performance, VerifyTreatment offers a solution built specifically for that challenge.