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Prevent post-adjudication revenue leakage with payment accuracy solutions

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Payment integrity activities are among the biggest drivers of administrative costs as payers must identify incorrectly paid claims and recover those funds from providers. Availity’s Payment Accuracy offers a better approach by improving claim accuracy early in the claim lifecycle with prospective, rather than retrospective, claims editing.

Leverage AI and automation to prevent avoidable denials

Availity’s Payment Accuracy offerings combine rich content with sophisticated edit technology and AI capabilities to ensure claim edits are applied as early as possible in the claim lifecycle. Payment Accuracy editing packages include:   

  • HIPAA (Snip levels 1-7)
  • Claim scrubbing
  • Clinical and analytics 
  • Pre-service
  • Risk adjustment

Shift left to accelerate administrative cost savings

Availity’s Payment Accuracy is built on the concept of “shifting left.” This means moving the evaluation of claims as early as possible in the claim lifecycle to prevent the waste and abrasion that happens when inaccurate claims reach the payer.

By evaluating claims at the Intelligent Gateway, before the claim reaches the payer, Payment Accuracy reduces phone calls related to pended or denied claims and helps prevent prompt-payment penalties.

Case Study

How one health plan realized more than $1 million in administrative savings with upfront claims editing

A regional health plan needed a solution that would reduce the costs associated with claims rework without increasing provider abrasion.

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Case Study

Upfront edits help a national health plan reduce Medicaid claim denials by 30% 

Availity Editing Services identifies and deploys targeted edits, reducing claim errors.

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Learn more about how Availity can help

Product

Intelligent Gateway

Learn how Availity can help you seamlessly connect and exchange administrative data with providers and other trading partners.

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