The Key to Fewer Denials: Unlocking Automation with Advanced Real-Time Eligibility

With revenue cycle management top of mind for many health systems, healthcare leaders are continuously seeking ways to streamline processes and reduce claim denials. When it comes to obtaining a full view of patient benefits, the current process is not as simple as it could be. Inadequate, fragmented data often hinders the ability to efficiently retrieve accurate, comprehensive benefits information, and manual processes can easily lead to frustration for patient access staff. Oftentimes, multiple queries are needed, which add unnecessary complexity and time to the process. And the complications do not just affect associates. When it comes to patients, the lack of timely cost-of-care estimates can harm their ability to plan for financial responsibilities.

Overcoming existing data challenges requires a solution that will streamline operations and improve the patient experience by providing faster, more transparent financial information. The key to achieving these goals is to unlock better access to patient benefits information through automation.

Enter Advanced Real-Time Eligibility (ARTE)

This is exactly the path one large health system took to address similar challenges. To solve increasingly cumbersome eligibility issues, the Advanced Real-Time Eligibility (ARTE) feature was the answer, available through Availity Essentials Pro™. The ARTE feature’s ability to deliver comprehensive eligibility results in a single transaction meant that instead of running multiple queries, the health system was able to access complete patient coverage information with one inquiry, significantly reducing the time and effort required.

Real-world results

Through the integration of the ARTE feature, the health system was able to transform its revenue cycle, reduce claim denials, and enhance the patient experience. By automating time-consuming processes and improving access to comprehensive benefits data, it achieved greater operational efficiency while empowering patients to make informed decisions about their care. Access our new case study to unlock more details around the ways the overall denial rate was reduced by 67% by partnering with Availity.  

To read how Availity’s solution seamlessly integrated into the health system’s existing electronic health records (EHR) workflows for better real-time patient eligibility and accuracy, access the complete case study here.

About the Author

Alanna Caracciolo serves as the Director of Product, Eligibility Solutions at Availity. Delivering solutions that improve day-to-day processes and outcomes is fundamental to her role at Availity, along with leveraging creative problem solving, data analytics and VOC to propel growth and strengthen client relationships.   Prior to joining Availity in 2023, Alanna spent two decades in the healthcare sector in various roles from clinical support to software management.

Director, Product Management at Availity 

• LinkedIn
• Mail