Availity

Availity is one of the largest health information networks in the United States, acting as a primary "clearinghouse" that connects healthcare providers to insurance payers.

History and Scale

• Founded: 2001 in Jacksonville, Florida.
• Origins: It began as a joint venture between Florida Blue (Blue Cross and Blue Shield of Florida) and Humana to streamline the administrative "friction" between doctors and insurance companies.
• **It has a massive national footprint, connecting over 2 million providers to nearly every major health plan in the U.S. (including 14 Anthem/Elevance states).
• Profitability: While Availity is a private company (backed by private equity firms like Novo Holdings and Francisco Partners), it is considered highly stable and profitable, handling over $2 trillion in billed claims annually.

Signature Products

Availity’s core business is the Availity Essentials portal, which provides:

• Eligibility & Benefits: Real-time verification of patient insurance.
• Claims Management: Electronic submission and tracking of medical claims.
• Remittance Advice: Digital delivery of EOBs (Explanation of Benefits).
• Patient Cost Estimator: Tools to tell patients their out-of-pocket costs before a procedure.

AI & Prior Authorization Strategy

Availity has heavily invested in AI to solve the "Prior Authorization" (PA) bottleneck, which is historically manual and slow.

• Availity Authorizations: Their main PA tool uses automated rules engines to determine if a procedure requires authorization instantly.
• Clinical Data Upcycling: Using technology from their Diameter Health acquisition, they use AI to "clean" messy clinical data (from EHRs) into a standardized format that insurance algorithms can read. This reduces the need for a human to manually review medical records for "medical necessity."
• Olive AI Assets: By acquiring Olive AI’s utilization management unit, they integrated "AI workers" (automated bots) that can log into payer portals, submit data, and check status without human intervention.

Acquisitions (Past 3 Years)

Availity has been on a strategic buying spree to move from a "data mover" to a "data refiner."

Employee & Growth Trends (2024–2026)

• Employee Pool: As of early 2026, Availity employs approximately 1,600 people in the U.S. and another 200+ in India.
• Growth vs. Shrinking: The company is currently in a transformation phase. While they are hiring for high-level AI, software engineering, and clinical data roles, they recently divested (sold) their offshore patient access outsourcing unit to AGS Health in 2023.
• Internal Shift: This suggests they are shrinking their "manual labor" pool (people who manually call insurance companies) and growing their "tech/AI" pool.

Summary for your project: Availity is the "giant" in your space. Their goal with the Olive AI and Diameter Health purchases was to own the "Prior Auth Automation". They have the data (the oil), and they recently bought the "refinery" (the AI) to process it.