Transforming Revenue Cycle Management through Data-driven Insights

Challenge

Revenue cycle management (RCM) in healthcare is often characterized by manual and time-consuming processes that require constant attention. This complexity frequently leads to inefficiencies and claims errors, resulting in unnecessary costs, overburdened staff, and delayed payments. Leadership sought to overcome challenges and reimagine its revenue cycle through the creation of processes that were more responsive to data analysis and easily integrated within staff workflows.  The organization experienced the common challenges associated with credentialing and electronic data interchange (EDI) enrollment. The biggest challenge – due to robust growth – was provider edits.

Solution

Exploring revenue cycle efficiency strategies and using principles of data science and analytics to identify trends, Availity aimed to produce cleaner claims and drive faster adjudication. A focus was placed on evidence-based, goal-driven strategies: integrating analytics and rigorous testing to inform decision-making.

One of the first steps was to uncover opportunities for improvement and identify key areas of the revenue cycle that were able to be automated. An investment in technology upgrades and reporting programs allowed the company to modernize its revenue cycle and streamline operations, reduce errors, and improve overall efficiency. 

Availity Revenue Cycle Management (RCM) is a comprehensive platform that helps providers and billing services streamline every phase of the revenue cycle from patient eligibility and prior authorizations to claims submission, remittance processing, and denial management. Built on Availity’s trusted dual-sided network, the solution delivers direct, real-time connectivity with payers and integrates seamlessly into existing EHR and billing workflows. By automating manual tasks, improving data accuracy, and reducing administrative overhead, Availity RCM helps providers accelerate reimbursements, minimize denials, and improve cash flow—all while reducing friction between front- and back-office teams.

Availity RCM was implemented with a suite of services offering key capabilities, including Secondary Drop to Paper, Worker Comp Automatic Claims and Attachments, and Automobile claims. An auto-assignment rule also was created within Availity’s Edit Error Management feature, designed to identify and resolve claim errors before they reach the payer. Unlike traditional post-adjudication models, Availity applies intelligent edits upstream.By integrating these edits within the claim workflow, users are able to catch issues earlier and reduce costly rework.

Providers receive clear, actionable error messages directly within their existing workflows, enabling first-pass claim accuracy and significantly reducing denials, appeals, and administrative overhead. By integrating payer-specific and third-party edit content at scale, Availity’s Edit Error Management helps ensure cleaner claims, faster reimbursements, and a more efficient revenue cycle.