What You Should Know:
– Availity, a real-time health information network launches Predictive Editing, a revolutionary feature within its Availity Essentials Pro™ platform.
– The AI-powered tool developed in partnership with Anomaly Insights empowers healthcare providers to significantly reduce claim denials, leading to smoother revenue cycle management and improved financial performance.
The Problem: Costly Claim Denials
Denied claims are a major pain point for healthcare providers, resulting in lost revenue and wasted administrative time. Identifying and correcting errors before submission can significantly improve claim acceptance rates.
Predictive Editing: A Powerful Solution
Availity’s Predictive Editing tackles this challenge head-on with its intelligent AI engine:
- Proactive Denial Detection: The AI analyzes vast amounts of claims data, identifying patterns that indicate potential denials before claims are submitted.
- Impressive Accuracy: A recent study involving over 100 million claims showcased the tool’s effectiveness, flagging over $828 million in potential denials with a remarkable 97% precision.
- Machine Learning Expertise: Developed in partnership with Anomaly Insights, a leader in healthcare AI/ML solutions, Predictive Editing continuously learns and adapts to evolving payer rules and claim adjudication patterns.
Key Advantages of Predictive Editing
- Automates Upfront Edits: Eliminates the need for time-consuming manual review of denied claims.
- Handles Complexities: Goes beyond traditional edit engines, addressing intricate payer-specific scenarios.
- Complementary Integration: Works seamlessly with existing editing tools, enhancing their effectiveness and reducing manual rule maintenance burdens.
“Availity’s Predictive Editing tool works in real-time within the workflow and it can review each claim and permutation of the claim as its being created, generating predictions with virtually no latency and returning guidance via API,” said Linda Perryclear, Senior Director of Product Management for Availity Essentials Pro. “With Predictive Editing, providers have a tool that drives a more seamless payment process for providers nationwide through Availity Essentials Pro.”
