Unlocking Automation with Advanced Real-Time Eligibility

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 and eligibility information. Manual processes can easily lead to frustration for patient access staff. Oftentimes, multiple queries are needed, which add unnecessary complexity. The complications do not just affect associates. For 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 provide faster, more transparent financial information. The key to achieving this goal is to unlock better access to patient 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, Advanced Real-Time Eligibility (ARTE) was the answer, available through Availity Essentials Pro™. ARTE’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 eligibility information with one inquiry. Therefore, time and effort was significantly reduced.

Real-world results

With ARTE, the health system was able to transform its revenue cycle, reduce claim denials, and enhance the patient experience. Further automating time-consuming processes and improving access to comprehensive benefits data achieved greater operational efficiency while empowering patients to make informed decisions about their care. Eligibility was streamlined and the overall denial rate was reduced by 67% by partnering with Availity.  

Read our latest case study to see how Availity’s solution seamlessly integrated into the health system’s EHR workflows, delivering better real-time patient eligibility and accuracy.

Read the Case Study

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.

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