specification: FinOps Framework
specificationVersion: '1.0'
schema: https://www.finops.org/framework/
provider: Availity
providerId: availity
created: '2026-05-04'
# Provenance stamped 2026-08-11: this artifact was written by the API Evangelist
# bulk sweep dated 2026-05-04, not harvested from the provider. See roadmap#35.
method: generated
modified: '2026-05-05'
reconciled: false
notes: Availity pricing is two-sided. Provider-side Essentials is free (paid by health plans). Trading
  partner / clearinghouse and Essentials Pro are quote-based. This artifact models both sides.
tags:
  - FinOps
  - FOCUS
  - Healthcare
  - HIPAA
  - X12 EDI
  - Clearinghouse
description: 'FOCUS-aligned FinOps for Availity: two-sided market with payer-funded provider portal
  (zero cost to provider) plus per-transaction clearinghouse fees and subscription RCM/Pro tiers
  billed to trading partners.'
sources:
  - https://www.availity.com/
  - https://www.availity.com/products
alignedWith:
  framework: FinOps Foundation Framework
  frameworkUrl: https://www.finops.org/framework/
  dataSpec: FOCUS
  dataSpecVersion: '1.3'
  dataSpecUrl: https://focus.finops.org/focus-specification/v1-3/
publisherName: Availity, LLC
serviceCategory: Healthcare Network / Clearinghouse
billingModel:
  pricingCategory: Subscription + Per-Transaction
  billingFrequency: Monthly
  billingCurrency: USD
  chargeCategories:
    - Purchase
    - Usage
    - Adjustment
    - Tax
    - Credit
focusColumns:
  ServiceName: Availity
  ServiceCategory: Healthcare Network / Clearinghouse
  ProviderName: Availity
  PublisherName: Availity, LLC
  InvoiceIssuerName: Availity, LLC
  BillingCurrency: USD
meters:
  - name: x12_transactions
    unit: transaction
    aggregation: sum
    dimensions:
      - transaction_set
      - payer
      - real_time_or_batch
  - name: eligibility_lookups
    unit: lookup
    aggregation: sum
    dimensions:
      - payer
  - name: claim_submissions
    unit: claim
    aggregation: sum
    dimensions:
      - payer
      - line_of_business
  - name: era_records
    unit: record
    aggregation: sum
  - name: essentials_pro_seats
    unit: seat
    aggregation: max
  - name: rcm_subscription
    unit: month
    aggregation: sum
principles:
  - name: Visibility
    description: Use the Availity reporting dashboards (Trading Partner reports, RCM dashboards) to
      see transaction counts by payer and transaction set; reconcile against monthly invoices.
  - name: Allocation
    description: Allocate by line of business (medical vs dental vs vision), payer, and submitting
      provider TIN; tag claims with internal cost-center / location codes.
  - name: Optimization
    description: Move from batch X12 to real-time eligibility for high-touch encounters; consolidate
      vendor connections through Availity to drop redundant clearinghouse fees.
  - name: Accountability
    description: Revenue cycle director typically owns Availity spend; payer-relations team owns
      configurations for participating health plans.
maintainers:
  - FN: Kin Lane
    email: kin@apievangelist.com