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Reduce denials, prevent inaccurate claim payments, and improve provider engagement

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Reducing the number of claims submitted with errors not only improves your auto-adjudication rates, but it helps reduce improper payments. But prepay and pre-adjudication edits only check claims after they reach the health plan.

A better approach is to edit claims before they are submitted and adjudicated. Availity’s Payment Accuracy solution moves claim editing much earlier in the claim lifecycle—into the provider EDI workstream—so errors can be identified and fixed before they affect claim and payment processing.

Leverage AI and automation to prevent avoidable denials and appeals

Unlike other claim editing solutions, Payment Accuracy leverages Availity’s dual-sided network, which transmits claims from the provider EDI workstream to the health plan. Claims are checked at our Intelligent Gateway and errors are returned to the provider for resolution.

Decrease manual reviews without increasing audits

You can improve claim processing efficiency without increasing payment integrity activities by stopping claim errors before adjudication. Early identification means fewer claims to manually process and less chance of inaccurate payments to providers.

Putting Payment Accuracy to work in your organization

Interested in best practices for implementing a successful Payment Accuracy program in your organization? Check out this Availity Connects webinar replay.

Case Study

Payment Accuracy Helps Reduce Medicaid Denials

Learn how one national payer prevented claims with errors and improved provider satisfaction

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Case Study

Payment Accuracy Helps Payer Realize Administrative Savings

A regional payer achieved measurable savings by implementing a small number of edits

Read the study

Learn more about how Availity can help

Product

Intelligent Gateway

Learn how Availity can help you seamlessly connect and exchange administrative data with providers and other trading partners.

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