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Availity is widely used for clearinghouse services, especially in handling claims, eligibility, and other payer-provider transactions. But if you’ve worked with the platform closely, you know that its core strengths lie in billing, not in managing the messy, ongoing reality of provider data.
As CMS regulations tighten and health plans are held accountable for inaccuracies, many organizations are discovering the limits of relying on a billing-first tool to handle data validation, roster reconciliation, or directory compliance. Manual workarounds, spreadsheet stitching, and siloed outreach are still surprisingly common even with a platform in place.
In this blog, we compare 10 carefully selected Availity alternatives based on how well they help healthcare organizations improve provider data accuracy, meet CMS requirements, and eliminate manual reconciliation. We evaluated each platform using clear criteria so you can identify which solutions best support a scalable, audit-ready provider data strategy.
Top 10 Availity Alternatives to Consider in 2025
When exploring alternatives to Availity, it’s important to assess how each platform aligns with your organization’s evolving provider data needs. The table below highlights key capabilities across these platforms, so you can quickly pinpoint which solutions support critical functions like CMS audit readiness, roster reconciliation, and ADA-compliant directory fulfillment. Use this view to guide your internal evaluation and identify the right fit based on your priorities.
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Solution
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AI & Automation
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CMS & Regulatory Readiness
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Roster Reconciliation
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ADA-Compliant Directory
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PRIME
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AI-prioritized tasks and outreach
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CMS audit trail, ADA-ready output
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Reconciliation + shared workflows
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Fully ADA-compliant directories
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Availity
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Claims + eligibility automation only
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CMS-aligned for transactions, not directories
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Not designed for roster reconciliation
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Not directory-focused
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Cohere Health
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Clinical AI for prior auth
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CMS-aligned for UM only
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Not supported
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No public directory features
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Perspecta
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CMS-aligned for directory only
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Roster-level input, not bidirectional
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Display-oriented, not fulfillment-ready
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QGenda
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Scheduling automation only
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Not CMS-aligned
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Not supported
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Not CMS-aligned
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Cedar
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Billing + coverage AI
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No CMS tooling for provider data
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Not supported
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Not applicable
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Health Gorilla
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Interoperability + data exchange
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TEFCA/DxF-aligned
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Not provider reconciliation focused
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No directory support
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Avaneer Health
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Real-time coverage correction
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NSA-ready, payer data compliance
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No provider data reconciliation
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Not applicable
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Epic Systems
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Workflow + EHR automation
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CMS + payer-aligned tools
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Limited reconciliation within Epic-only orgs
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Not ADA-optimized or standalone
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athenaOne
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Claims, billing, documentation AI
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CMS-aligned for revenue cycle
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Not designed for payer-provider reconciliation
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Not directory-focused
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CredentialStream
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Automation across credentialing lifecycle
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Credentialing-focused compliance
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Privileging-focused, limited roster tracking
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Not offered
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PRIME® by Atlas Systems
Many healthcare organizations turn to Availity for clearinghouse services. But when it comes to managing provider data, keeping it accurate, audit-ready, and compliant, Availity often leaves teams with manual work and gaps to close.
PRIME® changes that. Built by Atlas Systems, PRIME® gives you full control over the provider data lifecycle. It centralizes validation, automates outreach, and simplifies CMS compliance across payers and providers. Instead of toggling between spreadsheets and outdated directories, your team works from a real-time, AI-powered platform built for scale.
Why PRIME® might work for you
If you spend hours chasing roster updates or preparing for audits, PRIME® replaces that friction with automation and visibility. The platform cuts manual work by 85%, boosts data accuracy to 98%, and helps teams meet CMS’s 90-day verification rule without scrambling.
You can track every change, validate data at the source, and generate ADA-compliant directories, all in one place.
Top features
Automated provider validation:
Identify high-risk data gaps and trigger targeted outreach to verify provider information quickly and at scale.
Roster reconciliation:
Ingest incoming files, flag gaps or discrepancies, and route updates through AI-prioritized workflows for fast resolution and compliance tracking.
Directory fulfillment:
Deliver print-ready, ADA-compliant directories to support Medicare Advantage and CMS mandates.
FHIR-native design:
Share data instantly across EMRs, credentialing systems, and payer platforms.
Audit tools:
Track outreach activity, timestamps, and responses to build a clean audit trail.
Performance dashboards:
Monitor data status, campaign effectiveness, and risk indicators across your network.
Pros
PRIME® supports thousands of providers and hundreds of plans across U.S. health systems.
Teams reduce manual outreach by 85% and cut admin overhead by 50%.
You can deploy it as a platform, co-sourced service, or managed solution, based on your operational model.
PRIME® adapts to regulatory changes and interoperability needs without custom rework.
Cohere Health
Cohere Health focuses on transforming utilization management (UM) through AI-powered clinical intelligence. It automates prior authorizations and guides decisions using data extracted from structured and unstructured clinical records. Cohere offers flexible deployment models (in-house, delegated, or hybrid) and handles millions of authorizations per year through its API-first infrastructure.
Why Cohere Health might work for you
If you are looking to streamline healthcare payments and reduce friction across claims and contracting workflows, Zelis offers modular solutions that target those exact challenges. You can reprice claims in real time, gain visibility into contract performance, and automate the delivery of provider payments and communications.
Key features
Responsible clinical AI:
Extracts relevant medical data and applies plan-specific rules to support accurate and fast decisions.
Modular deployment:
Offers full-service delegation or UM augmentation depending on your team’s readiness.
Interoperable APIs:
Processes authorizations with CMS-0057-F compliant APIs (CRD, DTR, PAS).
Digital policy management:
Digitizes NCDs, LCDs, and custom medical policies to support automated decision-making.
Pros
Automates 90% of authorizations and reduces administrative costs by 47%.
Providers report satisfaction due to fewer delays and seamless integration with portals like Availity and Epic.
Cons
Cohere focuses heavily on prior authorization workflows, not on provider data validation or roster reconciliation.
It does not serve as a comprehensive provider data management solution, so you may still need additional tools to manage directory accuracy or CMS verification requirements.
Perspecta
Perspecta focuses on directory accuracy, compliance, and search optimization. It leverages AI and machine learning to maintain “authoritative” provider data across large-scale networks. Perspecta helps health plans reduce data fragmentation, correct outdated listings, and deliver a smarter provider search experience.
Why Perspecta might work for you
Perspecta centralizes provider data to help payers reduce fragmentation and improve search relevance across digital directories. Its tools support national and regional plans with large-scale data normalization, network performance filtering, and templated directory deployment. For organizations focused on front-end search and display optimization, Perspecta delivers measurable improvements, though it doesn’t extend into outreach, roster validation, or audit readiness.
Key features
ProviderDirectoryAI:
A consumer-facing search tool that ranks providers based on outcomes, language, specialty, and satisfaction ratings.
Provider Roster Management:
Helps reconcile network affiliations, updates, and terminations from plan-facing rosters.
Pros
Offers a scalable, API-first architecture that integrates with external systems and directories.
Includes consumer-focused tools to support search, transparency, and coverage visibility.
Cons
While Perspecta cleans and displays data, it doesn't manage the full lifecycle of provider validation, onboarding, and compliance tracking in real-time.
It does not offer integrated outreach or audit trail capabilities required for meeting CMS’s 90-day provider verification mandate.
Plans may still need additional workflow systems or services to handle credentialing, reconciliation, or member-facing compliance needs end-to-end.
QGenda
QGenda is a workforce management platform focused on optimizing clinical scheduling, credentialing, and time tracking across health systems. Its scheduling engine helps organizations improve shift equity and ensure clinical coverage at scale. While QGenda serves a wide variety of healthcare environments, it doesn’t center its offering around provider data accuracy or directory compliance.
Key features
Advanced Scheduling:
Automates schedule generation using provider rules, preferences, and availability.
Time and Attendance:
Tracks clock-in/out, leave, and productivity in real time.
Credentialing Integration:
Helps onboard providers and track expiring credentials.
Shift-Based Compensation:
Ties pay rules directly to scheduled shifts and tasks.
Pros
Improves time-to-credentialing by up to 66%, based on customer reports.
Offers strong usability, with consistent feedback on ease of scheduling and mobile access.
Cons
Users report a steep learning curve, especially when configuring complex rules or customizing views.
Several reviewers mentioned limited mobile functionality, with difficulty accessing full features on smartphones.
Users often rely on customer support to make changes, such as adding new provider profiles, which slows down onboarding.
Some teams experience server outages or platform lag during high-volume use.
Cedar
Cedar is a patient financial engagement platform that helps providers improve payment collections, billing clarity, and overall patient satisfaction. It specializes in patient-facing communication, delivering clearer bills, AI-driven billing support, and third-party coverage discovery to increase collections and reduce call center burden.
Key features
Cedar Pay:
A patient payment platform that consolidates bills, EOB insights, and HSA access into one simple experience.
Cedar Cover:
Helps patients discover and enroll in Medicaid, ACA plans, and assistance programs to reduce financial barriers.
Cedar Support:
Combines AI automation (via “Kora” voice assistant) with live agent support to resolve billing questions and reduce operational costs.
Pros
Increases patient payments and reduces collection costs through a digital-first experience.
Automates 30% of billing calls using AI, reducing live-agent demand.
Cons
Focuses exclusively on the financial experience, not provider data accuracy or directory compliance.
Does not manage provider roster validation, credentialing, or CMS-mandated 90-day verification workflows.
Not suited for organizations looking to centralize operational, clinical, and directory data across payers and provider networks.
Health Gorilla
Health Gorilla is a national interoperability platform designed to enable seamless, secure exchange of health information. As the only dual-designated QHIN and QHIO in the U.S., it gives organizations the infrastructure to participate in both the Trusted Exchange Framework and Common Agreement (TEFCA) and California’s Data Exchange Framework (DxF). Payers use the tool to improve risk adjustment, refine care models, and participate in emerging government incentives tied to data sharing.
Key features
QHIN and QHIO status:
Enables participation in both TEFCA (national) and CalHHS DxF (California state-level) initiatives.
Patient360 platform:
Builds a longitudinal, actionable record by aggregating clinical data from EHRs, labs, HIEs, and more.
Health Interoperability Platform (HIP):
Offers FHIR-based APIs, master patient index, and record locator services for national data exchange.
Pros
Offers full compliance with HIPAA, SOC 2 Type 2, and HITRUST R2 data protection standards.
Automates lab ordering, care alerts, and patient chart creation through developer-friendly APIs.
Cons
Focuses on interoperability and clinical data exchange, not on provider directory accuracy or credential lifecycle management.
Does not offer tools for CMS’s 90-day provider verification mandate, nor ADA-compliant directory publishing.
Lacks outreach automation and audit tracking tools that support proactive directory compliance.
Avaneer Health
Avaneer Health is a decentralized data exchange network built to streamline healthcare transactions between payers and providers, without relying on traditional clearinghouses or intermediaries. It enables peer-to-peer exchange, giving each participant full control over their data, encryption, and access.
Top features
Coverage Direct™:
Delivers real-time insurance coverage updates directly between payers and providers.
Private SparkZone™ environments:
Each organization retains complete control over its data-sharing policies.
Integrated analytics dashboard:
Allows users to identify and resolve coverage misalignments quickly.
Pros
Helps eliminate unnecessary write-offs, denials, and payment recovery costs.
Strengthens compliance posture with real-time updates and auditable transactions.
Cons
Designed for coverage resolution, not for broader network integrity tasks like managing affiliations, terminations, or public-facing listings.
The platform's impact depends on network participation—organizations not connected to the Avaneer Network won’t benefit from real-time data exchange.
While privacy and control are strengths, the decentralized model may limit visibility across systems compared to more centralized platforms.
Epic Systems
Epic is an electronic health record (EHR) platform in the United States. It connects hospitals, health systems, payers, and even research teams through a unified digital record. Through its Payer Platform, Care Everywhere interoperability framework, and integrated modules like Tapestry for health plans, Epic enables real-time claims data exchange, prior authorization tracking, and population health analytics.
Top features
Care Everywhere:
Enables seamless clinical data exchange across systems, Epic or not, supporting over 718M monthly record exchanges.
Tapestry:
Health plan administration suite supporting claims, membership, and care management.
MyChart:
Consumer-facing portal for scheduling, messaging, prescriptions, and cost transparency.
Pros
Powers deep interoperability, 54.3B API transactions, and 291B interface transactions annually.
Offers integrated support for research, population health, and quality reporting.
Cons
Users frequently cite a steep learning curve, especially for non-technical or new users unfamiliar with Epic’s unique terminology and navigation.
The interface feels outdated, with several reviewers comparing the UI to early-2000s software.
Customization and role-based access often require IT intervention, slowing down onboarding and user access to new features.
Quarterly updates are time-consuming, requiring testing and validation cycles that frustrate frontline users.
Epic’s closed ecosystem can create integration friction with third-party tools, especially for organizations that need modular or best-of-breed systems.
Athenahealth (athenaOne)
athenaOne is an integrated cloud-based platform that combines EHR, revenue cycle management, patient engagement, and payer data exchange. It delivers AI-powered documentation, automated claim workflows, and value-based care support through a single interface.
Key features
Integrated EHR and Billing:
Combines scheduling, charting, documentation, and revenue cycle workflows in a single view.
Patient Engagement Suite:
Supports mobile messaging, portal access, payments, and wellness outreach.
athenaPayer Tools:
Enables payer-provider data sharing, care gap closure, and electronic prior auth across a national network.
Pros
Helps reduce documentation time and patient follow-up workload with AI tools.
Offers real-time payer connectivity, care gap closure, and diagnosis suggestion tools.
Cons
Steep and time-consuming setup process, especially for practices without dedicated IT support.
Users frequently describe the interface as clunky and click-heavy, with documentation taking 20% longer than in previous EHRs.
Many report that coding dominates workflows, making physician documentation frustrating and inefficient.
Users complain of poor onboarding teams, confusing default configurations, and slow customer support responses.
Several reviews mention duplicated or irrelevant data imports, such as incorrect allergy records appearing in medication lists.
HealthStream (CredentialStream®)
CredentialStream® by HealthStream focuses on streamlining the provider credentialing, enrollment, privileging, and evaluation process. Used by systems like UNC Health and Sentara, it creates a single source of truth for provider information, enabling faster onboarding and improved revenue cycle performance.
Key features
Enroll:
Automates provider onboarding, payer enrollment, and recredentialing workflows.
Privilege:
Manages the clinical competency lifecycle across specialties and facilities.
Evaluate:
Tracks and analyzes provider performance using built-in FPPE/OPPE tools.
Bolt Automation:
Standardizes data input, validation, and routing to minimize manual entry.
The Hub:
Provides providers with a portal to track status, submit updates, and communicate with credentialing teams.
Pros
Supports faster onboarding and revenue cycle acceleration with automation tools.
HITRUST r2 certified for high-standard data security.
Cons
The platform focuses on internal credentialing and privileging workflows, not on external directory compliance or CMS-mandated provider data validation.
May require significant process alignment and staff training for organizations transitioning from fragmented credentialing tools.
HealthStream does not offer ADA-compliant directory publishing, roster reconciliation, or payer-facing audit automation.
Frequently Asked Questions (FAQs)
1. Are there cost-effective alternatives to Availity?
Yes. Solutions like PRIME® offer broader provider data capabilities without clearinghouse overhead, making them more cost-efficient for many organizations.
2. What are some notable alternatives to Availity for provider data management?
PRIME®, Perspecta, and CredentialStream stand out for provider validation, credentialing, and compliance - areas where Availity has limited support.
3. Does Availity support CMS-mandated provider data verification?
Not directly. It lacks the audit workflows and outreach automation required to meet CMS’s 90-day verification mandate.
4. Can these alternatives integrate with existing systems like Epic or athenaOne?
Yes. Most leading platforms, including PRIME®, offer API-based interoperability and FHIR-native architecture to support EHR and payer system integration.
