• Advances in completeness and accuracy expected to reduce the number of claims-processing errors and appeals, improve care provider and patient experiences, avoid unnecessary costs
  • Availity will implement Optum’s Advanced Claim Editing (ACE) solution into its Availity Health Information Network; Optum will use Availity’s network to connect to commercial and government health plans nationwide

Wakefield, Mass., and Jacksonville, Fla., Jan. 20, 2016Optum, a leading information and technology-enabled health services business, and Availity, the nation’s largest real-time health information network, will collaborate to help improve the completeness and accuracy of health insurance claims, and reduce claims-processing errors and appeals.

The partnership will help more than 900,000 care providers who use practice-management systems to exchange real-time administrative, financial and clinical information with government and commercial health plans nationwide through the Availity Health Information Network.

The companies announced that Availity will implement Optum’s Advanced Claim Editing (ACE) solution as a component of the Availity Health Information Network, and Optum will use the Availity Health Information Network to connect to commercial and government health plans nationwide.

By using Optum’s ACE solution, participating health plans can give care providers timely notifications and feedback on actionable errors or information gaps that often trigger claim denials. This means care providers are more likely to submit accurately completed claims and health plans can subsequently reduce claims-processing times and mitigate appeals that require costly investigation and recovery efforts. Also, patients are better able to accurately understand their financial responsibilities.

“By streamlining the claims process for health plans and care providers, ACE can take unnecessary cost and friction out of the health system, while improving patient experiences,” said Bill Miller, CEO of OptumInsight.

Optum will move a significant volume of its third-party commercial and government transactions to the Availity Health Information Network, thereby increasing Availity’s scope from 2 billion to more than 3 billion transactions annually. Through this partnership Availity will drive greater administrative cost savings for health plans by further streamlining engagement with their care provider networks.

“Availity’s rich feature-set and extensive network of care providers and health plans is an ideal home for Optum’s ACE solution,” said Russ Thomas, CEO of Availity. “Availity offers a single point of engagement for health plans and care providers, which leads to improved payment turnaround and more accurate claims submissions. We are delighted to have been selected by Optum to connect its industry-leading ACE solution to our broad national network of health plans.”

About Optum

Optum is a leading information and technology-enabled health services business dedicated to helping make the health system work better for everyone. With more than 100,000 people worldwide, Optum delivers intelligent, integrated solutions that help to modernize the health system and improve overall population health. Optum is part of UnitedHealth Group (NYSE:UNH). For more information, visit www.optum.com.

About Availity

As an industry-leading, HITRUST-certified health care information technology company, Availity serves an extensive network of health plans, providers, and technology partners nationwide through a suite of dynamic products built on a powerful, intelligent platform. Availity integrates and manages the clinical, administrative, and financial data needed to fuel real-time coordination between providers, health plans, and patients in a growing value-based care environment. Facilitating over 7 million transactions daily, Availity's ability to provide accurate, timely, and relevant information is vital to the financial success of its clients.

For more information, including an online demonstration, please visit www.availity.com or call 1.800.AVAILITY (282.4548).