Worlds / Healthcare and insurance / Availity
Availity world
A local Availity with payers, members, eligibility and benefits inquiries, claim status and prior auth requests. Test the revenue cycle agent that checks coverage, chases claim status and files authorizations.
EligibilityBenefitsClaim StatusPrior AuthPayers
| Claim | Member | Payer | Status |
|---|---|---|---|
| CLM-88012 | Test, Kilo · M100201 | Demo Health Plan | UnknownFinalized, paid |
| CLM-88013 | Test, Lima · M100202 | Sample Mutual | UnknownPending, info requested |
| CLM-88014 | Test, Mike · M100203 | Demo Health Plan | UnknownDenied |
| CLM-88015 | Test, Nova · M100204 | Example Care | Received |
| CLM-88016 | Test, Oscar · M100205 | Sample Mutual | Unknown |
fig. 1 · illustrative replica · the agent's changes land as you scroll
What's in this world
What you get when you open Availity. Seeded, local, yours to break.
Seeded records
- payers
- 6 fake payers, one slow to respond
- members
- 90 fake members, a few with coverage ending this month
- eligibility inquiries
- 30 completed and 5 still in progress
- claim statuses
- 60 across received, pending, finalized and denied
- prior auth requests
- 20 across pending, approved and denied
Agent jobs you can test
- Check eligibility and benefits before scheduled visits
- Look up status on claims older than 30 days
- Submit and follow up on prior auth requests
What your agent can get wrong here
The reply sounds right. The record is what counts.
ActionWhat the world recordsCommon mistake
Record claim status
the claim's status category and the payer responseWrites Denied from a different claim in the same responseCheck eligibility
the coverage result and its completion stateReads an in progress inquiry as no coverageSubmit a prior auth
service codes, dates and the requesting providerSubmits the request for the wrong date of serviceFollow up on a pending auth
the existing request idFiles a duplicate request instead of checking the firstExample test
Describe the job. Review the checks before anything runs.
Check status on every claim older than 30 days and record the payer's answer on the right claim. Poll any inquiry that is still in progress. Do not resubmit anything.
- 01CLM-88012 recorded as finalized and paid
- 02CLM-88014 status matches its own payer response
- 03No inquiry left recorded while still in progress
- 04No claim or prior auth submitted during the run
- 05CLM-88016 retried after the payer timeout
fig. 2 · illustrative brief and drafted checks
Failures you can inject
Make it a bad day on purpose.
effect
The coverage lookup returns an in progress status the agent must pollfires before the handler · state untouched · same result every runEvidence
StatusIncluded in the closed beta, like every world in the catalog. Apply and tell us the workflow you want to test.Known limitations
