Availity

What Availity does

Availity, LLC is a privately-held U.S. healthcare information network headquartered in Jacksonville, Florida, operating as a dual-sided real-time intermediary between U.S. health plans and healthcare providers. The company connects more than 95% of U.S. payers with over 3 million credentialed providers and 17,000+ B2B technology and trading partners, processing 13+ billion clinical, administrative, and financial transactions annually and approximately $4-5 trillion in billed claims. Availity's customer base spans commercial health plans, Blues plans, Medicaid and Medicare programs (Humana, HCSC, Florida Blue, BCBS Minnesota/Texas/Oklahoma, Highmark, Wellcare, Clover Health, Molina, Sanford Health, Point32Health, and Oklahoma SoonerSelect), large provider systems and physician groups (Piedmont, RadNet, Atrium Health), and a long tail of healthcare technology companies and RCM resellers (NextGen, Henry Schein MicroMD, MEDHOST, Raintree, ImagineSoftware, TSI Healthcare, Unlimited Systems, athenahealth, Salesforce Agentforce, Abridge, WNS-HealthHelp).

Availity's platform is built around an Intelligent Gateway processing HIPAA X12 EDI, SOAP, RESTful, and HL7 FHIR-native APIs, layered with proprietary products including Availity Essentials (a free multi-payer provider portal), Availity Essentials Pro (paid RCM automation), Availity AuthAI (analytical AI for prior authorization using Clinical Quality Language), Availity Extend (an MCP-based agent-ready developer activation layer), Intelligent Utilization Management, Payment Accuracy, Clinical Data Solutions (with a 400-rule optimization engine), Provider Lifecycle Solutions, Digital Correspondence, and a CMS-0057-F Interoperability Suite. A separate Availity Rapid Recovery cybersecurity framework provides sub-five-day restoration, independently validated by Mandiant. Engineering is delivered from a U.S. headquarters plus a growing Global Capability Centre in Bengaluru, India.

The revenue model blends usage-based clearinghouse transaction fees on the 13+ billion annual transactions, recurring enterprise platform licensing from health plans, paid Essentials Pro subscriptions from provider organizations, usage-based API/developer access fees via Availity Extend, and professional services/implementation revenue through a newly consolidated Customer Success organization. Distribution combines direct enterprise sales to payers and large providers, self-serve provider registration, a 30+ RCM reseller channel, an Availity Extend developer ecosystem, and a PMS/EMR/HIS marketplace with hundreds of integrations. Pricing is contract-driven and not publicly disclosed.

Name

Availity

Legal name

Availity, LLC

Website

https://availity.com

Company type

Private

Founded year

2001

Operating status

Operating

Headcount range

501–1,000 employees

Short description

Availity operates the nation's largest real-time healthcare information network, connecting 95%+ of U.S. payers with 3+ million providers and 17,000+ technology partners to process 13+ billion annual transactions across eligibility, prior authorization, claims, and payments.

Ownership category

akta.pro rank

Headquarters

HQ city

Jacksonville

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Software

Cost components

Technology or R&D, Personnel, Operations, Marketing or Sales, Infrastructure

Revenue model

1. Clearinghouse & Transaction Fees: Availity operates a national-scale EDI clearinghouse that processes 13+ billion eligibility, authorization, claims, and payment transactions annually. Revenue is generated on a transaction/usage basis across the Intelligent Gateway for both payers and providers.
2. SaaS Subscriptions (Essentials, Essentials Pro): Recurring subscription revenue from Availity Essentials (free for providers but monetized via payer contracts) and Essentials Pro RCM subscription tiers for provider organizations requiring full pre/post-service and post-adjudication automation.
3. Enterprise Payer Platform Licensing: Enterprise licensing revenue from health plans for the Availity Platform for Payers, including Multi-Payer Portal, Intelligent Utilization Management, Payment Accuracy, Clinical Data Solutions, Provider Lifecycle, Digital Correspondence, and CMS-0057-F Suite.
4. Professional Services & Implementation: Revenue from implementation, customer success, and ongoing services via the new Customer Success Organization combining Strategic Account Services and implementation teams to deliver measurable value to platform investments.
5. Developer Platform / API Access: Revenue from healthcare technology companies accessing Availity's network APIs and the Availity Extend developer experience / agent-ready activation layer to build and scale solutions.

Pricing tiers

Go-to-market motion3 records

Distribution channels6 records

Marketing channels10 records

Core offering

Availity operates a national-scale, dual-sided real-time healthcare information network connecting more than 95% of U.S. payers, 3+ million providers, and 17,000+ B2B partners via an Intelligent Gateway, FHIR-native APIs, and a unified administrative and clinical data platform. The company sells SaaS subscriptions, transaction-based clearinghouse services, and enterprise platform licenses spanning eligibility verification, prior authorization, claim submission, payment accuracy, clinical data exchange, and provider lifecycle management.

Differentiator

Problem solved

Functional benefit

Brands

• Availity Essentials: Multi-payer provider portal used for eligibility, prior authorizations, claims, remittances, and secure payer-provider collaboration.
• Availity Essentials Pro
• Availity AuthAI
• Availity Extend
• Availity Fusion
• Availity Rapid Recovery
• Availity Foundation
• Availity Intelligent Gateway
• Availity CMS-0057-F Interoperability Suite
• Availity Provider Lifecycle Solutions

Products and services

• Availity Essentials
• Availity Essentials Pro
• Availity Platform for Payers
• Intelligent Utilization Management with AuthAI
• Payment Accuracy
• Clinical Data Solutions

Quantifiable outcome

• 13+ billion healthcare transactions processed annually
• +14 more outcomes

Named customers18 records

Segments6 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration26 records

AI capability3 records

Feature8 records

Partnerships

32 partnerships are on record, tiered flagship, core and minor.

• ThalesflagshipTechnology or Integration · 15 June 2026Thales was selected by Availity to modernize its identity infrastructure using the Thales OneWelcome Identity Platform, replacing legacy systems that handle billions of transactions and millions of authentications. The platform provides a unified, flexible identity foundation to improve stability, reduce operational complexity, and deliver enterprise-scale resilience for the healthcare ecosystem.
• Identity FusioncoreImplementation/ SI/ Consulting Partner · 15 June 2026Identity Fusion served as Availity's long-time IAM advisor and implementation partner, coordinating the structured transition to the Thales OneWelcome Identity Platform.
• Abridge (extended into payer/research workflows)flagshipStrategic or Co-development Partner · 13 June 2026Abridge expanded its AI platform into payer, reimbursement, claims management, coding, prior authorization, and research workflows, with partnerships including Availity alongside Highmark Health, AHIMA, and several medical associations.
• LeaguecoreStrategic or Co-development Partner · 3 June 2026Point32Health digital transformation initiative in partnership with League and Availity to unify member/provider portals and mobile apps into a single personalized platform and streamline provider connectivity and communication systems.
• NLP Logix (GitHub Copilot Dev Days Florida)minorGTM or Marketing Partner · 28 April 2026Availity (alongside WineShipping, Bank of America, and PGA TOUR) participated as a speaker/panelist organization in NLP Logix's Florida GitHub Copilot Dev Days gathering on May 7th, 2026 in Nocatee, Florida.
• Cooperative Exchange / HL7 Da Vinci ProjectcoreStrategic or Co-development Partner · 17 April 2026Launched the Da Vinci Trebuchet Clearinghouse-to-Clearinghouse Prior Authorization Pilot Cohort alongside 11 other clearinghouse companies (Experian Health, Optum, TriZetto Provider Solutions, Waystar, etc.) to test HL7 FHIR-based prior authorization transactions and validate hybrid FHIR/X12 EDI workflows.
• AbridgeflagshipStrategic or Co-development Partner · 12 January 2026Strategic collaboration to launch a first-of-its-kind prior authorization experience focused on the clinician-patient conversation. Integrates Abridge's Contextual Reasoning Engine with Availity's FHIR-native Intelligent Utilization Management solution to enable real-time prior authorization and clinical documentation during clinical visits, with plans to expand across documentation gap visibility, authorization integrity, and broader revenue cycle collaboration.
• Palantir, Gainwell Technologies, Council for Affordable HealthcarecoreStrategic or Co-development Partner · 20 October 2025CMS awarded prototype contracts to Palantir, Gainwell Technologies, Council for Affordable Healthcare Inc., and Availity for the National Directory of Healthcare Providers and Services proof-of-concept phase, signaling growing civilian agency interest in Palantir.
• Onyx HealthcoreStrategic or Co-development Partner · 6 August 2025Launched a comprehensive CMS-0057 compliance platform for health plans powered by the Availity Network to help payers operationalize CMS-0057-F Final Rule compliance ahead of the January 1, 2027 deadline.
• VimcoreStrategic or Co-development Partner · 20 June 2025Partnership to streamline care gap notification and closure process by integrating Vim's provider workflow capabilities into Availity's network.
• MediStreamscoreStrategic or Co-development Partner · 18 June 2025Marked a decade of revenue cycle management innovation, automating $61B in healthcare payments for healthcare clients via integrated payment posting and remittance workflows.
• WNS-HealthHelpflagshipStrategic or Co-development Partner · 7 April 2025Strategic collaboration to transform payer-provider collaboration by integrating WNS-HealthHelp's AI-driven clinical engine and specialty programs into Availity's Intelligent Utilization Management solution, connecting over 95% of payers and 3+ million providers to streamline Utilization Management and prior authorization processes.
• Amazon Web Services (AWS)flagshipTechnology or Integration · 17 March 2025Availity modernizes healthcare technology through collaboration with AWS, using Amazon Q and Amazon Bedrock to increase productivity and accelerate code development; documented AWS reference architecture for Availity.
• RevSpringcoreTechnology or Integration · 14 March 2025Expanded partnership with integration of RevSpring's PersonaPay™ and Availity Essentials Pro™ to streamline patient payment workflows within Availity's RCM offering.
• SalesforceflagshipStrategic or Co-development Partner · 28 February 2025Salesforce's Agentforce for Health partnered with Availity (alongside athenahealth and Infinitus.ai) to automate administrative tasks such as benefits verification and prior authorization; addresses research showing 87% of healthcare staff work late weekly due to administrative burden.
• ConcertcoreStrategic or Co-development Partner · 9 January 2025Partnership to digitize and automate prior authorization for genetic testing workflows using Availity's Intelligent Utilization Management solution.
• Sanford HealthcoreStrategic or Co-development Partner · 10 December 2024Sanford Health partnered with Availity for enhanced Revenue Cycle Management, leveraging Availity's RCM platform to improve financial performance.
• Connective HealthcoreTechnology or Integration · 6 October 2024Collaboration to enhance clinical data quality and deliver meaningful clinical insights to providers through Availity Fusion, transforming Connective Health's clinical data into actionable patient summaries.
• Iodine SoftwarecoreStrategic or Co-development Partner · 4 September 2024Partnership to enhance clinical mid-revenue cycle for providers by combining Iodine Software's AI capabilities with Availity's network connectivity and RCM platform.
• athenahealthcoreStrategic or Co-development Partner · 19 August 2024Availity and athenahealth set out to modernize the prior authorization process by integrating Availity's Intelligent Utilization Management with athenahealth's EHR.
• MandiantcoreTechnology or IntegrationMandiant provides independent validation of the Availity Rapid Recovery framework, certifying the recovery environment so partners and customers can safely reconnect in just 5 days after a cyber incident.
• NextGen HealthcarecoreChannel Partner/ Reseller/ DistributorNextGen Healthcare resells Availity's clearinghouse and RCM products as part of its integrated EHR and practice management offering to independent practices.
• Henry Schein MicroMDcoreChannel Partner/ Reseller/ DistributorHenry Schein MicroMD bundles Availity's clearinghouse and RCM within its EMR and practice management solutions for healthcare providers.
• MEDHOSTcoreChannel Partner/ Reseller/ DistributorMEDHOST resells Availity connectivity within its integrated EHR and financial solutions for healthcare facilities.
• RaintreecoreChannel Partner/ Reseller/ DistributorRaintree (2,500+ implementations, 25,000+ daily users in therapy provider organizations) resells Availity's clearinghouse within its RCM and patient engagement platform.
• ImagineSoftwarecoreChannel Partner/ Reseller/ DistributorImagineSoftware (40,000+ physicians served) integrates Availity's clearinghouse within its billing automation and revenue management applications.
• TSI HealthcareminorChannel Partner/ Reseller/ DistributorTSI Healthcare resells Availity's clearinghouse within its customized NextGen Practice Management and EHR solutions for specialty practices.
• Unlimited SystemsminorChannel Partner/ Reseller/ DistributorUnlimited Systems (6,000+ specialty healthcare providers) resells Availity's clearinghouse within its Unlimited Financials revenue cycle platform.
• MedicatminorChannel Partner/ Reseller/ DistributorMedicat (leading EHR provider for college health and counseling clinics) is a preferred vendor partner reselling Availity connectivity.
• BestNotesminorChannel Partner/ Reseller/ DistributorBestNotes (behavioral health and addiction treatment EHR/CRM) resells Availity's RCM Resellers Program offering.
• EpicflagshipTechnology or IntegrationEpic is listed among hundreds of PMS/EMR/HIS systems that integrate with Availity's RCM solution; Atrium Health case study specifically cites Epic integration cutting workers' comp backlog by 98%.
• eClinicalWorkscoreTechnology or IntegrationeClinicalWorks is listed among hundreds of PMS/EMR/HIS systems with existing integration into Availity's RCM solution.

Scale indicators12 records

Recent moves7 records

Expansion highlights6 records

Direct peers

• Waystar: Direct competitor in healthcare clearinghouse and revenue cycle management, serving payers and providers with eligibility, claims, prior authorization, and patient payment workflows. Highly comparable to Availity Essentials Pro and the broader clearinghouse business, and a co-participant in the Da Vinci Trebuchet FHIR prior authorization pilot cohort.
• Experian Health: Healthcare-focused division of Experian offering patient access, eligibility, claims management, and identity verification. Directly competes with Availity in clearinghouse transactions, patient intake, and payer-provider data exchange, and is also a co-participant in the Da Vinci Trebuchet FHIR prior authorization pilot cohort.
• TriZetto Provider Solutions (Cognizant): Long-standing payer administration and provider solutions business within Cognizant offering EDI clearinghouse, claims processing, and utilization management. Directly comparable to Availity's payer-side platform business, and also a participant in the Da Vinci Trebuchet FHIR pilot cohort.
• Edifecs: Healthcare data interoperability and FHIR-native integration platform serving payers, providers, and HIT vendors. Comparable to Availity's CMS-0057-F Interoperability Suite and FHIR-native connectivity hubs, with overlapping use cases in CMS interoperability compliance.
• Inovalon: Payer-side cloud-based healthcare data platform offering eligibility, claims, quality, and risk adjustment analytics. Comparable to Availity's Clinical Data Solutions, Payment Accuracy, and payer-facing Intelligent Utilization Management offerings, with overlapping enterprise payer customer base.

Broad incumbents

• Change Healthcare (Optum): Largest incumbent in healthcare information exchange and clearinghouse, now owned by Optum (UnitedHealth Group). Directly overlaps Availity's payer connectivity and EDI clearinghouse business, but operates as part of a much broader Optum portfolio spanning payer services, analytics, and pharmacy — giving Optum scale advantages Availity must match through network effects rather than capital.
• athenahealth: Cloud-based EHR and revenue cycle management platform for ambulatory providers with a large network of practices. Both Availity partner and competitor — partnered to modernize prior authorization but also competing in provider-side RCM workflows that overlap with Availity Essentials Pro.

Emerging players

• Bamboo Health: Real-time care intelligence and care coordination network connecting payers, providers, and pharmacies. Comparable as a two-sided healthcare intelligence network with comparable FHIR-based interoperability and behavioral health focus, though smaller scale than Availity.
• Health Catalyst: Healthcare data and analytics platform serving payers, providers, and health systems with data warehouse, analytics, and AI capabilities. Comparable to Availity's Clinical Data Solutions and clinical data optimization engine, with overlap in healthcare AI and CMS quality programs.

Others

• Surescripts: Nationwide health information network focused on e-prescription and pharmacy benefit data exchange. Analogous network-effect business to Availity but in the pharmacy vertical; relevant comparable for understanding two-sided healthcare network economics even though it does not directly compete in payer-provider administrative transactions.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat7 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/Availity
• GitHubgithub.com/availity
• YouTubeyoutube.com/@availity
• Facebookfacebook.com/availity
• LinkedInlinkedin.com/company/availity
• Instagraminstagram.com/availity

Compliance5 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles11 records

Subsidiaries2 records

Funding overview

Funding rounds2 records

Investors2 records

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A4 records

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Availity