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Prevent and manage claim denials to collect more revenue

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In the battle against claim denials, revenue cycle leaders need a two-pronged approach: denial prevention to stop claims with errors from reaching health plans and denial management to speed up the process of working denied claims to resolution.

Availity supports both denial prevention and denial management strategies with robust revenue cycle tools to help provider organizations reduce days in A/R, improve cash flow, and reduce write offs.

Develop customized claim edits with rich content and self-service tools

Automating the creation and maintenance of claims edits can improve clean claim rates and reduce denials. Availity Essentials Pro™ offers a robust editing content packages built on industry standards, along with well a self-service editing tool, allowing revenue cycle staff to: 

  • Create practice-specific messages and actions
  • Activate state-specific rule sets specific to clinical coding and billing scenarios
  • Provide an additional layer of edits for Medicare and Medicaid claims

Capture changing health plan requirements with AI-powered denial prediction

Payers change their rules often, but providers shouldn’t have to wait for claims to be denied before they implement edits to avoid them. Essentials Pro’s Predictive Editing solution leverages AI to check claims to see the likelihood of denial, allowing revenue cycle staff to fix them before submitting to the payer.

Predictive Editing highlights likely denials based on recent claim history, captures complex edit scenarios, and displays edits within the provider EHR.    

Reduce denial backlog with a streamlined claim correction process

Without enough staff to work denials, providers end up leaving money on the table. Essentials Pro helps drive more efficiency across provider organizations with automated and streamlined denial management that allows revenue cycle staff to:    

  • View errors in real time and correct in an online queue 
  • Create a standardized correction process  
  • View error patterns and trends   
  • Work multiple claims at once
Case Study

Future-proofing the revenue cycle through automation and innovation  

How one large health system streamlined their eligibility and benefits process with Availity’s Advanced Real-Time Eligibility solution.

Read the study

Learn more about how Availity can help.

Product

Availity Essentials Pro

Boost efficiency, prevent denials, expedite payments with Availity Essentials Pro End-to-End RCM.

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Resource

Denial Prevention eBook: The Ultimate Denials Survival Guide
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Resource

Denial Prevention eBook: Why Manage What you can Prevent?
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Resource

Availity 2024 Revenue Cycle Management Buyer’s Guide
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