ACE allows providers to clean claims before adjudication
One of the best ways to reduce administrative costs related to bad claims is to make sure they are clean before they reach your health plan. Availity Advanced Claims Editor (ACE) resides within the Availity gateway and edits claims pre-receipt—before they reach your adjudication system.
- Best-in-industry knowledgebase accumulates commercial, Medicare, and Medicaid claims processing guidelines from more than 80 sources.
- Customizable rules engine comprised of hundreds of edits configured to address claims processing factors stored in the knowledgebase.
- Claim scrubbing based on edits defined by the health plan.
- Messaging to providers based upon what is interpreted as incorrect or incomplete data.
- Claims history allows health plans to see all claims that come through the Availity Platform.
- Operational savings from reduced rework associated with pended, denied, or contested claims.
- Improved provider satisfaction by streamlining claims processing and reducing tasks required to manage denials and inquiries.
- Claim payment savings by avoiding overpayments caused by duplicate claims, duplicate lines, or overstated levels of care.
- Improved risk and analysis through customized reports and business insight.