Fine-tunes edits to gain higher auto-adjudication rates, fewer rejections

JACKSONVILLE, Fla. – Florida’s largest health insurance plan, Florida Blue, is using Availity Revenue Cycle Management (RCM) as the latest tool in its arsenal to improve administrative workflow, payment accuracy and efficiency for its network providers who also use Availity RCM. By enabling cleaner inbound claims from its network providers—achieved through careful editing of its plan-specific automated adjudication criteria—the company is looking to gain up to 4 percent fewer rejected inbound claims, 7.5 percent higher auto-adjudication rates, and a decrease of more than 3 percent in time-consuming claim denials. These metrics are based in part on the results of another large multi-state health plan that’s been using Availity’s tools for the past 18 months
Most often, revenue cycle management tools such as advanced claims editors are used by health care providers to reduce processing errors and get paid faster. Availity can help insurers identify the opportunity for additional efficiency gains for claim intake among its providers who use Availity RCM, and is encouraging its network providers to adopt Availity RCM technologies by accelerating claim processing among those providers who use it.
“The truly progressive insurance plans are finding novel ways to use provider-facing RCM tools to improve the payment process, streamline work and remove costs from the system,” said Russ Thomas, Availity’s chief executive officer. “They are driving for efficiency gains while also pursuing ways to ease provider concerns over speedy and accurate payment during times of industry change, which is a really smart approach.”