AVA Systems -Use Case Summary

Tools built to support member-facing teams, clinicians, providers, and brokers with communication, coordination, and guided access to care.
Includes: 

• CRM Application - used by agents to manage inbound and outbound calls, run outreach campaigns, and document member interactions. It provides a comprehensive, real-time view of member data—plan details, authorizations, claims, and more—surfaced through an integrated AI assistant.
  Fully interconnected with systems like Authorizations, Claims, Utilization Management, and Messaging, enabling seamless access to member context without system switching.
   
• Jump Start Assessment (JSA) - is a clinician-facing tool used to schedule member assessments and complete tailored question sets based on the member’s care plan.
   
• Care on Demand - is a provider-facing tool that surfaces real-time patient data, including care gaps and HEDIS scores, and enables appointment scheduling based on clinical needs.
   
• Virtual PCP - enables members enrolled in specific AVA plans to schedule video visits with their designated primary care provider directly through the member portal.
   
• Member Enrollment  - is a broker-facing tool with a centralized enrollment database and built-in digitization features. It allows brokers to upload, scan, and convert paper or faxed enrollment forms into structured digital records for processing.

Tools designed for healthcare providers to access patient data, manage care workflows, and conduct virtual consultations. 

• Patient data access tools that surface member clinical history, care gaps, HEDIS measures, and plan information—all in one view to support informed care delivery
   
• Care on Demand for scheduling visits based on clinical gaps and real-time patient need
   
• Virtual PCP functionality for providers to conduct secure video consultations with members enrolled in eligible plans
   
• Jump Start Assessment (JSA) tracking interface to help providers coordinate and manage scheduled assessments
   
• AVA Scheduler, a centralized calendar for booking and managing patient appointments and services
   
• Telehealth infrastructure supporting secure follow-ups and remote patient care

Tools designed for care teams to coordinate visits, track documentation, and prioritize member outreach based on clinical risk and care gaps. 

• Patient 360 - Centralized view of a member’s clinical history, plan details, care gaps, and open tasks
   
• Coder 360 - Used to track documentation, manage clinical review records, and support coding workflows
   
• Patient Priority - Prioritizes members for outreach based on risk scores, open gaps, and visit status
   
• Care Anywhere - Enables remote care coordination, documentation, and follow-up task assignment
   
• Panel Management - Organizes patient panels for care team oversight and population health tracking
   
• Utilization Management - Tracks service approvals, denials, and reviews for care authorization workflows
   
• Census - Real-time visibility into patient admissions, discharges, and transfers across care teams
   
• Care Management - Supports long-term care planning, interdisciplinary notes, and member case tracking
   
• Dashboards – Used by clinical teams to monitor care progress, documentation status, and gap closure

Tools designed for internal teams to manage core healthcare operations—claims, authorizations, eligibility, disputes, and administrative workflows.
Includes: 

• Claim Auditor - Used to review and validate insurance claims for accuracy, discrepancies, and potential fraud
   
• Claim Inquiry - Enables real-time claim status lookups and resolution of disputes
   
• Appeals and Grievances - Used to manage member-submitted complaints, appeals, and resolution workflows
   
• Provider Appeals and Disputes - Handles appeals initiated by providers on claims or service decisions
   
• Authorizations - Submits, processes and tracks authorization requests for treatments and procedures
   
• Utilization Management - Supports decisions around care approvals, denials, and medical necessity reviews
   
• Member Enrollment - Tool for enrolling new members, verifying eligibility, and digitizing paper/fax submissions
   
• Provider Data - Manages provider credentialing, affiliations, and profile details
   
• Agent Work List - Assigns, routes, and tracks daily operational tasks across teams
   
• Audit History - Maintains a full log of changes made to member records, claims, and authorizations
   
• Encounter 360 - Aggregates patient encounter data across all care settings for internal ops visibility
   
• Reports Submission - Automates generation and delivery of regulatory and performance reporting
  
   

Applications designed to support quality management teams in tracking performance metrics, closing care gaps, and preparing for audits.
Includes: 

• Stars performance dashboards - that visualize key quality measures across teams, regions, and care categories
   
• HEDIS tracking applications - to monitor open and closed care gaps at the member level
   
• Gap closure workflows  - that flag incomplete care tasks and help coordinate follow-up with clinical teams
   
• Audit preparation applications  - for tracking documentation status, submission readiness, and compliance trends
   
• Data export and reporting features  - to support regulatory submissions and internal quality reviews

 AVA Systems isn't just a platform, it's proof that design-led thinking can transform an entire healthcare ecosystem.