How RadNet Achieved a 1.45% Claim-Error Rate with Availity’s Real-Time Eligibility

About RadNet

RadNet is one of the largest providers of freestanding fixed-site outpatient diagnostic imaging in the country. With 10,000 employees and 398 imaging centers in eight states, RadNet completes more than 10 million outpatient imaging procedures annually.

Background

RadNet has been a longstanding user of Availity’s RTE feature since 2015, which has contributed to them being consistent with maintaining low error rates in their claims submissions. This is achieved through RTE’s comprehensive eligibility responses, offering detailed patient coverage insights while ensuring that RadNet incurs only one charge per inquiry and response transaction. Additionally, Availity’s seamless integration with RadNet’s electronic health record (EHR) allows staff members to efficiently request and access real-time patient eligibility and benefit information at the point of care. This integration has made Availity’s RTE feature a crucial part of RadNet’s operations, automating eligibility inquiries and assisting with its high accuracy in claims processing.

Solution

Despite the challenges, RadNet was determined to stabilize its operations. With the help of Availity’s RTE feature, they focused on regaining lost payer electronic data interchange (EDI) connections and reducing eligibility-related errors, which were significant contributors to its high error rates. By reestablishing EDI connections with payers through Availity and automating and streamlining eligibility checks, they dramatically cut down the initial error rates. Additionally, RadNet utilizes Advanced Claims Editing (ACE) within Availity RCM to efficiently create and manage custom edits and rules, helping them address potential issues before they occur. This proactive approach has been instrumental in maintaining consistent low error rates over the years and enabled them to quickly recover to low error rates following the cybersecurity incident.

In April, just two months after the incident, RadNet’s error rate dropped from 8.29% to 2.89%. Through relentless effort and strategic resource allocation, RadNet achieved a significant milestone in its revenue cycle management. By March 2025, its error rate had fallen to an impressive 1.45%, the lowest in its history. This significant reduction allowed RadNet to process claims with greater efficiency, reduce revenue loss from denials, and enhance overall financial performance.

Results