Research Report: Introducing the Availity Abrasion Index

If you can measure payer-provider abrasion, you can mitigate it.

Healthcare leaders know that administrative processes—though essential—can create friction between payers and providers. From prior authorization requests to post‑adjudication claim recoupments, each interaction carries the potential for inefficiency, delay, or frustration. But when that friction turns into disrupted workflows, delayed decisions, higher costs, and eroded trust, it becomes something more consequential. It becomes abrasion. 

Today’s healthcare ecosystem is too complex, too interdependent, and too resource‑constrained to tolerate avoidable abrasion. It wastes time, drains staff capacity, drives up costs, and undermines the patient experience. Yet until now, abrasion has been difficult to quantify—let alone address. 

That’s why Availity developed the Availity Abrasion Index, a comprehensive research report that measures payer‑provider abrasion across six administrative domains. The Index not only helps us understand where and why abrasion occurs but also offers a clearer path toward meaningful improvement. 

This executive summary highlights the most important findings and why they matter for every healthcare leader striving to build stronger, more resilient operations. 

How We Measured Abrasion 

Availity’s research combines qualitative interviews with quantitative survey insights from leaders across health plans and provider organizations. To build a multidimensional picture, the Availity Abrasion Index assesses abrasion across several of the most critical administrative domains, including: 

• Eligibility 

• Prior authorization 

• Claims 

• Payments 

• Clinical data exchange 

• Denials 

• Payment integrity 

Participants were asked to rate their agreement with statements describing operational realities or challenges within each domain. Their responses were then used to generate abrasion scores on a 1–5 scale, with 5 representing the highest level of perceived abrasion. 

The approach surfaced not only the severity of abrasion within each domain but also differences—sometimes subtle, sometimes significant—between payer and provider perspectives. 

For example, in the eligibility domain, health plans were asked whether they struggle to determine if a patient has other coverage, a challenge that can lead to coordination‑of‑benefits (COB) issues and disrupt claims processing. Providers, meanwhile, were asked whether payer requirements—such as COB‑related forms—add unnecessary administrative burden. Notably, both groups often rated the underlying processes in similar ways, indicating shared recognition of friction points even when the root causes may be viewed differently. 

What the Availity Abrasion Index Research Reveals 

Several themes re-emerge consistently in the Availity Abrasion Index, painting a picture not of one‑off failures, but of dual-sided, cumulative burdens. 

1. Timing, Uncertainty, and Coordination Are Central Pain Points 

Whether examining denials, eligibility, claims, or payments, leaders described how abrasion often results from misaligned timing, unclear expectations, or gaps in coordination. Delayed responses, shifting requirements, and inconsistent documentation standards routinely cause downstream problems that ripple across organizations. 

2. Abrasion Occurs Both Within and Between Organizations 

The research makes clear that abrasion is not merely a payer‑provider conflict. Instead, many of the costliest failures happen between organizations, particularly during moments of handoff, such as when upstream signals are misinterpreted or when decisions are reversed long after actions have been taken. 

But internal processes also matter. Fragmented workflows, staffing constraints, and inconsistent data downstream contribute to widespread rework and manual intervention. 

3. Digital Doesn’t Always Mean Durable 

While digital transformation has helped streamline some processes, participants emphasized that digitization alone does not guarantee smooth workflows. Abrasion still occurs when technology systems interpret data differently, when timing is misaligned, or when digital interactions amplify—rather than resolve—recurring process failures. 

4. Variability Compounds Complexity 

One recurring source of abrasion is the sheer variation across: 

• Payers and plans 

• Employer benefits 

• Lines of business 

• Vendor solutions 

• Documentation rules 

This variability often overwhelms even well‑designed automation, making outcomes harder to predict, explain, or defend. 

The Payer Perspective: Abrasion Runs in Both Directions 

A notable insight from the research is the degree to which payers themselves experience abrasion, sometimes at levels equal to or greater than what providers report. 

Payers described facing: 

• Operational overload driven by customization, volume, and exception handling 

• Fragmented, legacy technology that hinders consistency 

• Employer‑driven variation that increases administrative complexity 

• Reputational risk tied to denials, audits, and payment integrity processes 

This underscores that abrasion is not simply something payers “cause” and providers “experience.” Instead, both groups operate in systems that can unintentionally create burden. 

The Throughline: The Erosion of Trust 

Among all the themes that emerged, trust stands out as both a root cause and a downstream consequence of abrasion. 

Trust erodes when: 

• Eligibility responses vary later in the process 

• Documentation is requested after the fact 

• Denials occur despite prior steps taken 

• Payments are reversed long after adjudication 

These late‑stage changes force organizations to defend decisions using incomplete or outdated context, straining resources. As trust breaks down, defensive behaviors rise—screenshots, redundant documentation, increased appeals, and extensive manual validation. These behaviors, while understandable, further raise costs and amplify abrasion across the system. 

In this way, trust isn’t simply a “soft” metric. It’s a material operational risk. 

Where Payers and Providers Agree—and Diverge 

Despite the challenges, the research uncovered substantial areas of alignment: 

• Both groups cite prior authorization, denials, and payment integrity as major sources of abrasion. 

• Both believe earlier visibility, clearer rules, and more standardized processes would significantly reduce abrasion. 

• Both identify long-tail issues—such as late denials or unexpected audits—as particularly disruptive. 

Yet meaningful gaps remain. Providers often see denials, takebacks, and documentation requests as one‑sided punitive measures. Payers view them as necessary for good financial and regulatory stewardship. Payers rely on automation to scale; providers experience automation as accelerating denials without improving clarity. 

Where workflows break, both groups are aligned. Where responsibility lies, they are much less aligned. 

This divide underscores the importance of shared visibility and common standards—without which collaborative problem‑solving becomes difficult, if not impossible. 

What This Means for Healthcare Leaders 

The implications of the Availity Abrasion Index are clear: reducing abrasion is not simply about fixing isolated workflows. It requires shared infrastructure, aligned timing, and mutual accountability. 

To reduce abrasion at scale, payers and providers need: 

• A neutral, shared trust layer that standardizes inputs across organizations 

• Consistent, predictable administrative signals 

• Increased visibility into documentation, rules, and data dependencies 

• Tools that reduce manual rework 

• Collaborative operating models that move beyond transactional interactions 

This is precisely where Availity’s role becomes most strategic. As connective infrastructure for healthcare’s administrative ecosystem, Availity helps payers and providers orchestrate workflows with greater transparency, reduce variability, and support more durable operational trust. 

By grounding these improvements in data and shared insights, the Availity Abrasion Index offers a roadmap for leaders ready to transform abrasive processes into opportunities for efficiency, alignment, and better patient care. 

For a deeper dive into each domain and actionable recommendations, click the button below.

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