Whole Health Network

Name

Whole Health Network

Legal name

Availity, LLC

Website

https://wholehealthpro.com

Company type

Private

Operating status

Operating

Headcount range

1–10 employees

Ownership category

akta.pro rank

Product category

Healthcare Information Exchange

NAICS

Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (5182)

SIC

Services-Health Services (8000)

akta.pro primary industry

Healthcare Billing & Patient Payments Presentment (FSAMAJAH)

akta.pro secondary industry

Health Data, Vital Statistics & Population Health Informatics (BPAIAJAM)

Keywords

• Healthcare information network
• Revenue cycle management
• Payer-provider connectivity
• Healthcare interoperability
• Clinical data exchange

Headquarters

HQ city

Jacksonville

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Software

Cost components

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

Revenue model

1. Healthcare Information Network Services: Availity operates as the nation's largest health information network, facilitating over 13 billion clinical, administrative, and financial transactions annually. Revenue is generated through transaction processing fees and platform subscriptions for payers and providers.

Go-to-market motion1 record

Distribution channels3 records

Marketing channels4 records

Core offering

Operates as the nation's largest health information network, facilitating over 13 billion clinical, administrative, and financial transactions annually between health plans, providers, and healthcare technology partners. Provides real-time eligibility verification, claims processing, prior authorization, payment accuracy, and clinical data exchange through a unified multi-payer portal and developer-extensible platform.

Product overview

Availity operates as a multi-product healthcare information network platform that facilitates real-time collaboration between health plans, providers, and healthcare technology partners. The platform processes over 13 billion clinical, administrative, and financial transactions annually. The company offers a unified platform architecture with separate solutions for payers, providers, and health IT companies, along with specialized modules for specific workflows including revenue cycle management, utilization management, payment accuracy, clinical data exchange, and regulatory compliance (CMS-0057-F). The payer and provider platforms share core connectivity infrastructure while offering tailored workflow automation for each stakeholder type, and the Health IT segment provides connectivity and developer tools (Availity Extend) for technology partners to build on the network.

Differentiator

Problem solved

Functional benefit

Brands

• Availity Essentials: Multi-payer portal solution for providers
• Availity Essentials Pro
• Availity Extend
• Availity Foundation

Products and services

• The Availity Platform for Payers Enterprise platform enabling health plans to streamline workflows, improve collaboration with provider networks, and operationalize core administrative processes through real-time data exchange.
• The Availity Platform for Providers Platform solution for hospitals, health systems, and provider organizations focused on reducing denials, getting paid quickly and accurately, and streamlining revenue cycle staff workflows.
• Multi-Payer Portal Collaborative portal solution enabling provider network collaboration by automating core workflows across multiple payers from a single interface.
• Intelligent Utilization Management Solution that transforms the prior authorization process to help ensure patients receive the right care at the right time.
• Payment Accuracy Solution that reduces administrative waste by shifting claims edits early in the claim lifecycle to prevent incorrect payments.
• Clinical Data Solutions Platform that makes clinical data work for health plans by streamlining acquisition, improving quality, and optimizing workflows.
• Provider Lifecycle Solutions Solution that improves the quality of provider data for use across the enterprise throughout the provider lifecycle.
• Digital Correspondence Solution that drives cost out of provider communications by digitizing paper correspondence processes.
• CMS-0057-F Solution Suite Interoperability solution suite that operationalizes CMS-0057 with compliant FHIR APIs and scalable interoperability on a trusted national network.
• Network Connectivity for Payers Connectivity solution that enables health plans to connect to the most providers and HIT partners nationwide.
• Network Connectivity for Providers Solution that improves revenue cycle performance with fast and secure connections to payers nationwide.
• Revenue Cycle Management Automated RCM solutions covering pre-service, post-service, and post-adjudication phases to help providers prioritize care and reduce denials.
• Eligibility & Coverage Tool for verifying patient eligibility and coverage information through a trusted partner network.
• Authorizations Solution for managing and reducing time spent waiting for authorization approvals from payers.
• Claim & Claim Status Tools for reducing claim denials and accelerating reimbursement by providing real-time claim status visibility.
• Denial Prevention & Management Revenue cycle tools that support denial prevention and management, reducing write-offs and optimizing cash flow.
• Health IT Overview Overview page for healthcare technology companies offering foundational connectivity to network-powered innovation solutions.
• Clearinghouse & Trading Partner Network National-scale transaction processing and trusted connectivity across eligibility, claims, and payments for healthcare technology partners.
• Availity Extend Modern developer experience and agent-ready orchestration layer for building and automating real healthcare workflows on the Availity network.

Segments3 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature6 records

Partnerships

Eleven partnerships are on record, tiered supporting.

• LexisNexissupportingTechnology or IntegrationLexisNexis provides identity verification services as part of Availity's user verification process for B2B sites, supporting NIST IAL2 identity verification standards.
• ImageNet ConsultingsupportingTechnology or IntegrationImageNet provides privacy policy and identity verification services supporting Availity's user verification processes.
• ClearsupportingTechnology or IntegrationClear provides identity verification services supporting Availity's user authentication and verification requirements.
• ThalessupportingTechnology or IntegrationThales provides privacy policy and identity verification services as part of Availity's third-party vendor ecosystem.
• Google (reCAPTCHA)supportingTechnology or IntegrationGoogle reCAPTCHA v3 is used to protect Availity's website and forms from spam, fraud, abuse, and automated data extraction.
• WorkdaysupportingTechnology or IntegrationWorkday is the third-party vendor utilized for employment information collection and management.
• OneTrustsupportingTechnology or IntegrationOneTrust provides cookie consent management and privacy notice services for Availity's compliance requirements.
• InMomentsupportingTechnology or IntegrationInMoment provides Net Promoter Score survey privacy policy services for customer feedback collection.
• GainsightsupportingTechnology or IntegrationGainsight provides survey privacy policy services for additional customer feedback collection.
• QualtricssupportingTechnology or IntegrationQualtrics provides survey privacy policy services for customer feedback collection.
• PendosupportingTechnology or IntegrationPendo provides survey privacy policy services for additional customer feedback collection.

Scale indicators1 record

Recent moves4 records

Expansion highlights5 records

Emerging players

• 1upHealth: 1upHealth provides a healthcare data platform for FHIR-based interoperability and CMS compliance, overlapping with Availity's CMS-0057-F interoperability suite and broader connectivity infrastructure.
• Redox: Redox offers healthcare API integration and interoperability services, competing in the FHIR-based connectivity space that overlaps with Availity Extend and CMS-0057-F compliance offerings.
• Infinx Healthcare: Infinx provides healthcare RCM, prior authorization, and patient access solutions, with overlapping revenue cycle management and authorization capabilities that compete with Availity's provider-side offerings.
• Health Catalyst: Health Catalyst provides healthcare data and analytics platform for health systems, with adjacent clinical data exchange and analytics capabilities that intersect with Availity's Clinical Data Solutions offerings.

Direct peers

• Change Healthcare (Optum): Change Healthcare, now part of Optum/UnitedHealth Group, was historically the largest healthcare clearinghouse and competes directly with Availity in payer-provider connectivity, claims processing, and RCM. It is the most direct comparable given overlapping product portfolios and target customers.
• athenahealth: athenahealth provides cloud-based EHR, RCM, and patient engagement solutions for healthcare providers, with overlapping RCM and payer-connectivity capabilities that compete with Availity's provider platform.
• Zelis: Zelis provides healthcare payments optimization, claims management, and provider network solutions, competing directly with Availity's payment accuracy and payer-provider collaboration offerings.
• Edifecs: Edifecs offers healthcare data interoperability, compliance management, and payer-provider collaboration solutions, directly overlapping with Availity's CMS-0057-F interoperability suite and clinical data exchange products.
• Experian Health: Experian Health offers healthcare data analytics, eligibility verification, claims management, and patient access solutions, overlapping with Availity's payer-provider connectivity and RCM product lines.
• Waystar: Waystar provides cloud-based healthcare revenue cycle management and payment solutions, directly competing with Availity's RCM, claim processing, and patient payment offerings for hospitals and health systems.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/whole-health-network

Revenue estimate

Valuation estimate

Number of profiles

Funding overview

Funding rounds

Investors

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

M&A

Investments

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

Frequently asked questions about Whole Health Network