AI Admin Agents for Providers and Plans

Automate
Eligibility on Availity with AI

GenHealth can automate Eligibility for organizations using Availity by executing workflows autonomously for actions taken over the web and fax

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Trigger

When events happen in Availity

New data or events occur in Availity that need to be processed.
Availity

Polling for new records

Action

Automatically run Eligibility

GenHealth processes the Eligibility workflow automatically using AI.
Process Eligibility

Create or update records

How To Guide

How to automate Eligibility on Availity

Follow these steps to set up automated Eligibility for Availity using GenHealth's UMPA app. No code required.
1
Sign up for UMPA

Create your free GenHealth UMPA account to get started.

Sign up
2
Add Availity integration

In UMPA, connect Availity by entering your username and password.

Connect
3
Add a Eligibility workflow

Create a new workflow in UMPA and select Eligibility as the type.

Add workflow
4
Schedule the workflow

Choose your triggers or schedule (event-based or recurring) and go live.

Schedule
Start automating Eligibility
Benefits

Why automate Eligibility with Availity?

Save Time

Eliminate manual data entry and reduce processing time by over 80%

Reduce Errors

AI-powered automation ensures accuracy and consistency

Keep Your Workflows

No need to replace Availity - automate on top of your existing systems

Get Paid

More accurate Eligibility leads to faster payments with fewer denials

Details

How does it work?

1
Connect Availity

GenHealth can link your Availity account

2
Configure Workflow

GenHealth will setup your Eligibility automation rules and preferences

3
AI Takes Over

GenHealth automatically processes Eligibility tasks as they come in

4
Monitor Automation Reports

Track performance via reports

Get started with Availity + Eligibility automation
App

More about Availity

By leveraging AI, GenHealth can streamline billing processes for the Availity app, automating tasks such as claims submission and revenue cycle tracking to enhance efficiency and reduce errors.

View all Availity automations
Workflow

More about Eligibility

Selects the right path per carrier — API, clearinghouse, or portal RPA — and parses raw responses into structured benefits (deductible, coinsurance, out-of-pocket, plan rules). Writes back to the EMR and attaches the eligibility PDF to the patient record. Runs embedded in intake or standalone: ad-hoc, scheduled, or event-driven.

View all Eligibility integrations
More Workflows

Other Availity Automations

Medical Necessity

Selects the right LCD, NCD, commercial guideline, or custome...

Prior Authorization

Assembles payer-specific packets from intake and qualificati...

Resupplies

For each eligible patient: checks payer-specific resupply po...

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