How RadNet Increased Clean Claim Rate and Reduced Denial Rates

Executive Summary

Challenge:

High volume of claims requiring manual rework due to errors and denials

Solution:

Availity Revenue Cycle Management (RCM)

Results:

1.45% Claim Error Rate

Generated $336M More in Charges

$3.5M Historical Low in Error Impact

Timeline:

12 months

Client Info

Company: RadNet

Size: 10,000+ employees

Location: Nationwide

Industry: Outpatient Diagnostic Imaging

Background

RadNet’s commitment to operational excellence was put to the test in February 2024, when a cybersecurity incident disrupted payer connections and caused a surge in claim errors. Leveraging Availity RCM’s Real-Time Eligibility (RTE) and Advanced Claims Editing (ACE) features, RadNet rapidly reestablished electronic data interchange (EDI) connections, automated eligibility checks, and implemented custom edits and rules. This proactive approach enabled RadNet to reduce its claim error rate from 8.29% to 2.89% in just two months and ultimately achieve a historic low of 1.45% by March 2025. The result: a dramatic increase in clean claim rates, reduced denial rates, and enhanced financial performance.

Challenge

In early 2024, RadNet faced an unprecedented crisis when a cybersecurity incident led to widespread disruptions across the healthcare industry. The loss of payer connections and interruptions in claims, remittances, and eligibility transactions caused RadNet’s claim error rate to spike to 8.29%, creating a significant backlog of unpaid claims and straining revenue cycle operations. Staff were forced to redirect resources to manage the crisis, and the organization grappled with delayed reimbursements, increased administrative costs, and uncertainty about when normal operations would resume.

Key Challenges:

Loss of payer connections and EDI disruptions
Surge in claim error rates and backlog of unpaid claims
Increased administrative burden and resource allocation
Delayed reimbursements impacting cash flow

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 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.

“Availity’s RTE feature has been a game changer for us following the cybersecurity incident. The automation of eligibility checks has dramatically reduced our error rate from 8.29% to 1.45% and cut our financial impact from errors to $3.5 million. This has significantly improved our revenue cycle management and boosted our confidence in claim submissions. With Availity’s dedication and focus on the situation at hand they helped get us right back to normal volumes. We couldn’t have done it without them!”

Arika Reilly, Revenue Cycle Operations

Results

Error rate reduced from 8.29% to 1.45% (lowest in RadNet’s history)

$3.5M financial impact from errors
(down from $17M–$20M average).

$366M increase in charge volume
in 2024 vs. 2023.

Conclusion

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.

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How RadNet Increased Clean Claim Rate and Reduced Denial Rates

Executive Summary

Challenge:

Solution:

Results:

Timeline:

Client Info

Background

Challenge

Solution

Results

Conclusion

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