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Prevent Avoidable Claim Denials by Fixing Errors Before Pre-Adjucation

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Preventable claim errors lead to unnecessary denials, delays, and extra work for both payers and providers. Most payment accuracy and payment integrity solutions identify issues after the claim is already inside a health plan’s system — when the plan has no choice but to work the denial, respond to an appeal, or reprocess the claim.

Unlike denial management or traditional payment integrity programs, which address issues after adjudication, Payment Accuracy operates before claims enter the health plan’s system — preventing errors instead of correcting them downstream.

Availity delivers claim error prevention through its Intelligent Gateway — evaluating claims at submission before they enter a health plan’s processing environment.

When an issue is identified, a clear response is returned through the provider’s existing EDI workflow, so errors are corrected upstream and first-pass claim quality improves.

Availity’s Payment Accuracy is Built for Better

Built for Better Interoperability

Claims are evaluated at our Intelligent Gateway, which connects 95% of payers to over 3 million providers’ EDI workflows.

Built for Better Experience

Providers see exactly what needs to be fixed and why, improving cleaner first-pass claims and reducing confusion, follow-up calls, and costly rework for both sides.

Built for Better Scale

Because Payment Accuracy operates at the Intelligent Gateway, no new tools or integrations are required. Health plans reach millions of providers through a single connection and expand their payment accuracy initiatives without adding complexity.

Built for Better Decision Making

Resolving errors before the processing clock starts eliminates time pressure that can force health plan claims teams to prioritize speed over accuracy.

Proven Payment Accuracy Results

Learn how one national payer reduced denials and improved their provider experience in 3 months.

30%

Reduction in Denials

$500,000

Savings in Annual Penalty Fees

$6,000

savings per day in administrative rework

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“Fixing errors before claims are denied eliminates costly delays that can take weeks to resolve. Providers described the ability to fix errors at submission as a breakthrough that strengthened collaboration and trust”

VP, Claims Administration

Catch Common Coding Errors.

The Claim Scrubbing package goes beyond the basics – catching frequent errors such as HCPCS, CPT® codes, National Drug Code (NDC), and duplicate claims.

Address Complex Clinical Coding.

The Clinical & Analytics package targets clinical code errors, modifier usage, diagnosis and related services, Fraud Waste & Abuse, Medicare NCD/LCD, and Medicaid state-specific codes.

Resolve Payer-Specific Policy Errors.

The Payer Guidelines package ensures claims align with each payer’s unique rules, using payer-supplied policies, rosters, and reimbursement guidelines.

How Payment Accuracy Fits Into the Claims Lifecycle

Traditional payment integrity solutions identify errors after adjudication, when denials, appeals, and rework have already begun.

Availity Payment Accuracy operates earlier:

Claim Submission

Intelligent Gateway and Payment Accuracy Validation

Pre-Adjudication

Adjudication

Post-Payment Review

By validating claims at submission — before they enter a health plan’s systems — errors are resolved upstream, reducing avoidable denials, administrative work, and provider abrasion.

Ready to move from denial detection to prevention?

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Frequently Asked Questions

Understanding Payment Accuracy

What is payment accuracy in healthcare?

Payment accuracy in healthcare is the practice of identifying and resolving claim errors after submission but before adjudication. Also known as prospective payment integrity, it validates claims pre-adjudication to prevent incorrect payments and administrative rework.

What’s the difference between payment accuracy and payment integrity?

Payment accuracy focuses on preventing errors upstream, before adjudication occurs.
Payment integrity traditionally focuses on detecting and correcting errors after adjudication, often through post‑payment review, audits, or recoveries.
In short: payment accuracy is preventive, while payment integrity is corrective.

How is Availity’s Payment Accuracy different from pre‑payment or prospective payment integrity solutions?

Because Availity Payment Accuracy is native to the Intelligent Gateway, claims are evaluated outside the health plan, before they enter the payer’s pre‑adjudication environment. Issues are identified at submission, so providers can correct them early—resulting in cleaner first‑pass claims and fewer avoidable denials.

Workflow & Operational FAQs

When in the claims lifecycle does Availity Payment Accuracy operate?

Availity Payment Accuracy operates at the Intelligent Gateway, before a claim ever enters a health plan’s systems. This timing allows errors to be addressed early—before they become denials, adjustments, or appeals.

What happens when an error is identified on a claim?

When an issue is detected, a clear, specific message is returned to the provider through their existing submission workflow. The provider can correct the issue and resubmit the claim, helping prevent avoidable denials and downstream rework.

Will providers need to learn a new workflow for Availity Payment Accuracy to work?

No. Providers continue using their existing claim submission workflows and tools. Availity Payment Accuracy delivers feedback within those workflows, so providers do not need to adopt new portals, processes, or training to participate.

Does Availity Payment Accuracy require new integrations or tools?

For health plans using Intelligent Gateway, no. Availity Payment Accuracy leverages Availity’s existing network connectivity and operates through established claim submission pathways, avoiding the need for new point‑to‑point integrations or standalone tools.