Sanford Health Partners with Availity for Enhanced RCM

Health system was among the first organizations to use Availity Lifeline services in wake of industry cyberattack

Availity®, the nation’s largest real-time information network, announced that Sanford Health has selected Availity Essentials Pro revenue cycle management solution. The agreement will simplify the health system’s claim and payment processing through an integrated, all-payer clearinghouse with pre-service, post-service, and post-adjudication capabilities.

Sanford Health’s decision to partner with Availity was accelerated by the company’s experience with Availity Lifeline, a solution designed by Availity to provide crucial support to organizations impacted by the February 2024 cyberattack on the Change Healthcare clearinghouse. Availity Lifeline offered free connectivity for critical transactions, including eligibility and benefits, claims and claims status, and remittance advices, for the duration of the months’ long ransomware attack.

When the cyberattack occurred on February 21, Sanford Health immediately cut off connections to the clearinghouse. This safeguarded their own systems but also meant that no claims could be electronically submitted to health plans. Within days of implementing Availity Lifeline, Sanford Health was able to resume processing clean claims and receiving reimbursements.

Sanford Health was among the first of more than 300,000 providers and 50 health plans across the nation to implement Availity Lifeline, which was stood up within 48 hours of the cyberattack and has since processed more than 186 million claims with an estimated value of $315 billion.

The largest rural health system in the United States, Sanford Health, based in Sioux Falls, South Dakota, serves more than 1.4 million patients and nearly 200,000 health plan members. The integrated health system includes more than 42,000 employees who serve across 48 medical centers, 211 clinic locations, and 160 Good Samaritan Society senior living centers. Known for its commitment to high-quality patient care and innovative healthcare solutions, Sanford Health submits approximately 12 million claims a year across all lines of business, with an annual operating revenue of $13 billion.

“The cyberattack put our health system under tremendous pressure to get claims out the door,” said Tony Morrison, Vice President of Revenue Cycle at Sanford Health. Within four days, Sanford was up on Availity Lifeline and was able to process claims again. “Availity’s commitment to customer success and their expertise in change management, were key factors in our decision to go with them long-term,” said Morrison.

Sanford Health hopes to mitigate future cyber events through this partnership with Availity to minimize financial impact to the organization.

Availity Essentials Pro serves over 2 million providers across hospitals, health systems, and group practices. The solution addresses critical healthcare revenue cycle pain points with features like pre-service denial management, post-service claims management, and streamlined vendor interactions. It offers advanced tools for claim edits, AI-enabled predictive editing, and remittance solutions, enhancing data quality and reducing errors. The platform also provides real-time eligibility verification, patient engagement tools, and robust analytics for informed decision-making. Availity Essential Pro’s integration into Epic electronic health record systems for end-to-end revenue cycle is used by more than 145 hospitals, health systems, and group practices across the nation, representing 112 million covered lives and 12 billion transactions every year.

“Availity is committed to providing our partners with the highest level of security, operational efficiency, and customer support,” said Russ Thomas, CEO of Availity. “We are proud to support Sanford Health in their mission to deliver exceptional care. Our partnership will not only enhance their revenue cycle operations but also ensure the reliability and resiliency necessary to navigate today’s complex healthcare landscape.”

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