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Avaneer Coverage Direct™

Accurate coverage information is vital for payers and providers. Even if you already have coverage discovery tools, you may be missing coverage information due to the limitations of EDI, clearinghouses, and portals. Avaneer Coverage Direct™ provides payers and providers instant access to the latest coverage information.

Prevent First-Pass Denials

Our analysis shows that at least 20% of first-pass claim denials are caused by coverage-related reasons such as:
  • Incomplete view of coverage data, even when using clearinghouses and EDI
  • Inactive, incorrect, or invalid coverage information
  • Conflicting coverage information

Get Accurate, Real-Time Coverage Information

Avaneer Coverage Direct includes the following features:

  • Shares real-time data directly between solution participants without third-party involvement
  • Normalizes data in any format into a common FHIR standard
  • Matches patients/members between providers and payers to identify coverage misalignment
  • Identifies missing, conflicting, inactive, incorrect, or invalid coverage information
  • Exports data back into the EHR or to a preferred system
  • Enables review and remediation through user-friendly analytics dashboard

An Easier Way to Get More Accurate Coverage

With Avaneer Coverage Direct, coverage information is refreshed daily and always available without having to call payers or search payer websites. The solution reveals misalignments and errors in payer and provider coverage information, allowing registration problems to be resolved upfront, streamlining patient access workflows.

Avaneer Coverage Direct reduces

How it Works

Every solution participant contributes patient/member data to their SparkZone™, their private environment on the Avaneer Network™, where Avaneer Coverage Direct evaluates each participant’s coverage information. Updated data is automatically pushed in real time to each participant’s source system so that corrections can be auto-posted and made available for use.

Coverage data is never aggregated and is shared directly between participants without third-party involvement.

Lowers Costs and Improves Results

Avaneer Coverage Direct gives providers and payers confidence that they always have the latest and most accurate coverage information in their source systems.

Payer

Payers lower administrative and operational costs and discover net-new COB opportunities beyond existing solutions.

LEARN MORE ABOUT THE VALUE TO PAYERS >

Provider

Providers reduce denials, lower total cost of revenue cycle operations, and decrease write-offs.

LEARN MORE ABOUT THE VALUE TO PROVIDERS >

How Payers Benefit

Joining the network and using Avaneer Coverage Direct delivers administrative cost savings, improves member satisfaction, reduces provider friction, and creates an opportunity to seamlessly adopt upcoming solutions.

  • Provides immediate hard savings from improved administrative efficiencies, more accurate claim adjudications, and fewer provider calls
  • Streamlines discovery of COB leads
  • Reduces recovery costs (payment integrity)
  • Improves member satisfaction
  • Alleviates provider friction and improves provider relations
  • Lowers clearinghouse costs

How Providers Benefit

Having accurate coverage information is key to an efficient revenue cycle. Avaneer Coverage Direct delivers accurate, real-time coverage information directly from the payer's to the provider’s system. In addition to cost savings, providers can improve the patient experience and payer relations.

  • Provides immediate hard savings from improved administrative efficiencies and reduced denial rework
  • Reduces write-offs
  • Eliminates retroactive prior authorizations
  • Improves regulatory posture (No Surprises Act)
  • Improves patient financial experience and patient retention
  • Lowers clearinghouse costs

Request a Product Tour

During the tour you will learn:
  • How providers and payers connect once to the Avaneer Network and have direct access to each other 
  • How data is shared directly between participants without third-party accessing or aggregating data 
  • How coverage information is refreshed daily and accurate updates are automatically pushed to participant source systems 
  • What happens when coverage information is misaligned and how payers and providers use the more accurate data
  • How to calculate savings potential for your organization

Join us as we reinvent the business of healthcare!

Avaneer Insights

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