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Coverage Direct: The Catalyst for Better Payer-Provider Relationships

February 19, 2024

I’ve spent over a decade in health information exchange, and while I’ve witnessed many incremental attempts to remove barriers and alleviate payer-provider friction, I’ve never seen true payer-provider partnership to reinvent and solve the core of revenue cycle management – coverage information.

Health insurance coverage is a notable example of unnecessary friction. While adoption of electronic eligibility transactions has reached 94%, payers and providers still struggle with sharing coverage data in a way that is automated, complete, accurate, and timely. A significant challenge has been a lack of interoperability, but that’s changing!

The Avaneer Coverage DirectTM solution detects and matches changes in coverage information and instantly shares it with payer and providers. In doing so coverage information is accurate, up to date, and immediately accessible. Our payer and provider participants are thrilled with the results. Providers appreciate the significant reduction in coverage-related denials and payers share how the solution helps simplify coordination of benefits.

I’m really excited to be a part of this transformational moment in healthcare. Also, I invite you to reach out to me or take a product tour to learn the value of Avaneer Health’s Coverage DirectTM solution.

David Schramm
Senior Product Manager, Avaneer Health


In This Issue

From the Avaneer Podcast

The Spark: Lessons Learned from an Industry Disrupter

Sufian Chowdhury, founder and CEO of Kinetik, envisions a future where healthcare transportation mirrors the convenience of popular ride-sharing services like Uber and Lyft. Chowdhury sits down with Avaneer CEO Stuart Hanson and Marketing VP Rachel Schreiber to share the many insights he’s gleaned since setting out to transform the non-emergency medical transportation (NEMT) industry—an industry whose services can mean life or death for millions of individuals each year.

Listen to the podcast

Industry Highlights

Researchers Call for Outcome-Centric Approach to Health AI Regulation

Health IT Analytics

The recent White House Executive Order on the Safe, Secure, and Trustworthy Development and Use of Artificial Intelligence seeks to prevent the irresponsible use of AI that “fraud, discrimination, bias, and disinformation; displace and disempower workers; stifle competition; and pose risks to national security,” especially in vital fields like healthcare. However, researchers believe the order omits a critical component: patient outcomes. This insightful article delves into the need for “outcomes-centric” regulations whereby companies with new AI-driven models should be required to prove clinical relevance before being allowed to bring the model to market.”

Read more

Healthcare Administrative Spending Increased by 50%

Rev Cycle Intelligence

Healthcare organizations are getting hit from all sides by rising expenses, especially labor and pharmaceuticals. The 2023 CAQH Index Report reveals that administrative expenses are also taking an increasing toll on the bottom line, reaching nearly $83 billion, with prior authorization, claim submission, and claim status inquiry taking the top spots. This insightful article delves into the challenges and recommends strategies for thriving in this post-pandemic “new normal.”

Read more

Doctors and hospitals praise new prior authorization rule, but some want more from Congress

Chief Healthcare Executive

The recent CMS final rule focused on overhauling the highly burdensome prior authorization process has been much anticipated and, most would argue, long overdue. However, critics of the rule say that while it’s a significant step in the right direction, it does little to advance real-time processes and reduce the number of prior authorizations overall—both of which are essential to reducing the burden of prior authorizations on providers.

Read more

From the Avaneer Blog

What if getting accurate patient coverage could be easier?

What if providers and payers could connect to a single network and access always-refreshed, accurate, and complete primary, secondary, and tertiary patient coverage in real time—without needing a third party? Providers could spend less time chasing information and more time with patients while IT would have fewer connections to manage, reducing costs and freeing up valuable resources.

“What if” is now a reality at some of our nation’s largest payer and provider organizations.

Read the blog

Looking to Connect?

Find us at these upcoming conferences or book a time to meet.

ViVE 2024 is just around the corner, and we’re looking forward to talking with payers, providers, and like-minded innovators and entrepreneurs about the exciting things happening at Avaneer Health. If you’d like to meet with our CEO, Stuart Hanson, while at the show, please reach out here.

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