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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

Challenge  

An academic medical center and its six regional hospitals, recognized as a top health system by U.S. News & World Report for more than a decade, was looking to achieve greater efficiency. Like many health systems of their size, the busy central billing office transitioned to Epic EHR in 2017, but quickly outgrew their revenue cycle clearinghouse vendor within a few years of implementation. When evaluating a new partner, a robust Epic integration was top-of-mind, but the transition team also identified product reliability and uptime, consistent customer service, and cutting-edge features as key needs. 

Solution 

The client worked with Availity to implement Essentials Pro to increase automation in their revenue cycle and set a trajectory for long-term innovation. Within days of implementation, the team was excited to see their clean claim rate jump by 1.5 percent — an estimated savings of $432,000 annually.* The clean claim rate improvement was a result of automated, robust edits — especially around eligibility — that exposed errors at the front end of the revenue cycle and reduced the rework required for denials. In just a few months, real-time eligibility (RTE) automation increased and success rates dramatically improved, reducing frontoffice workloads and sustaining their stellar clean claim rate. With the robust benefits details returned through Essentials Pro, the client also started automating patient estimates, which will further accelerate collections while increasing patient satisfaction. 

The billing team estimates that 35 hours of weekly manual work is now automated thanks to Essentials Pro, and they’re excited to introduce new automated capabilities like claim status and claim attachments in the next phase of their implementation. 

“Our clean claim rate (following implementation) was phenomenal, which speaks to the number and quality of the edits and then our ability to see issues and react to them quickly”

– A director-level associate responsible for revenue cycle management

Results

  • 35 hours of weekly manual work automated  
  • Clean claim rate improved from 96.5% to 98%  
  • 96% of payers connected through RTE; Epic best practice is 91%  
  • Top 25% in Epic Financial Pulse for Coverages Auto Created via RTE and Medicare Replacement Chaining

Essentials Pro is Availity’s premium, all-payer clearinghouse empowering some of the nation’s largest hospitals and health systems with revenue cycle automation, AI, and expert client consultation. 

 A more robust sibling of the payer-sponsored Essentials portal you know, Essentials Pro is deeply integrated with most major EHRs and HIS’ to streamline your processes, backed by Availity’s unparalleled payer connections and relationships.

Get to Know Essentials Pro

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