A member’s coverage situation can change numerous times throughout their lives or even in a single year, making it challenging for payers to identify accurate and complete coverage information to determine the primary payer. Having complete coverage information is critical for payment integrity, optimal operational efficiencies, and effective cost containment. Without it, payers must invest in time-consuming research and manual management of coverage-related appeals, as well as higher call center volumes and increased provider friction. Also, payers may unnecessarily struggle to meet employer contractual commitments.
In addition to ongoing staffing challenges and skyrocketing expenses, payment integrity issues increase a payer’s financial risk and negatively impact the member experience.
Payers now have a more effective way to identify complete, accurate coverage information to determine the primary payer. Avaneer Coverage Direct™ gives payers a direct connection to all providers and all other payers on the Avaneer Network™, simplifying and improving the sharing of primary, secondary, and tertiary insurance information without aggregating the data or sending it to third parties outside the network. Data remains safely within the network and under the complete control of the data originators.
When a change is made to a member’s coverage, Avaneer Coverage Direct identifies missing, conflicting, incorrect information, and new coverage availability, instantly “pushing” this insight update to all network participants providing services to the member. Immediately sending updated information to all permissioned payers and providers ensures providers have correct coverage information at the point of care and payers will have fewer first-pass denials to manage. Sharing new and complete coverage information also delivers increased Coordination of Benefits (COB) leads, improves insurance primacy validation, and lowers provider calls. The result is reduced administrative burden, significant cost savings, and improved member satisfaction.
Avaneer Coverage Direct is just one of the solutions available on the Avaneer Network, a digital network and platform that simplifies the business of healthcare. Designed as a modern IT infrastructure for sharing healthcare data, Avaneer Health enables payers to work with their providers more easily, which ultimately benefits the member.
Each payer and provider participating in the Avaneer Network receives their own provisioned cloud environment, known as a SparkZone™. Once a participant loads coverage information for their members/patients into their SparkZone, the Avaneer Coverage Direct process begins:
Avaneer Coverage Direct launched with two large national payers and a nonprofit, multi-specialty health system with nearly 80,000 employees worldwide. Like many payers, establishing the primary payer is vital for controlling costs and improving payment accuracy. However, the payers’ and provider’s available data is siloed and latent, and current methods for discovering dually-covered members are challenging and limiting. Despite their best efforts, current technology and manual processes don’t provide complete coverage information. Even when the data is found, the information may be incorrect, conflict with other coverage information, or it is not comprehensive and does not represent the individual’s full benefit picture. Bad coverage data leads to denied claims, write-offs, delayed reimbursement, and lost revenue.
The first of its kind, Avaneer Coverage Direct connects the payers and the provider directly. With this single connection to the Avaneer Network, payers and providers can share real-time, current, minimally necessary granular data with those having permissioned access. Data is never centralized or aggregated, allowing each payer and provider to retain control of their data using their encryption keys.
With Avaneer Coverage Direct, the payer experienced short-term hard savings of between $0.57 to $1.65 per claim.
The payer also experienced an increase in payment integrity, issue resolution, and coverage primacy. With a reduction in manual workflows, the payer can reassign staff to more strategic tasks.
It’s time to move past outdated, labor-intensive administrative processes that increase friction, reduce member satisfaction, and cost payers billions. Avaneer Coverage Direct makes it possible.
Learn how your organization can benefit from Avaneer Coverage Direct.
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