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What if you could lower denials for good?

April 17, 2024

Until now, capturing accurate benefit information has been a manual, resource-intensive process that involves calling payers and combing payer websites to find the right information. Even when found, there’s no guarantee the information is correct. This inability of payers and providers to share coverage information is caused by complex data exchange processes. In other words, payer and provider systems don’t speak to each other. They lack the flexibility and specificity to accurately and fully communicate benefit information.

Avaneer Health recently launched its solution, Coverage DirectTM, which enables payers and providers to share coverage data directly without having to create or maintain multiple connections or use third parties. I’ve worked at various healthcare technology organizations and I see this approach to solving the problem as being very unique and impactful to payers, providers and patients. Connecting directly to update coverage information is more efficient, accurate, and timely. Features include:

  • Providers connect once to the Avaneer Network and have direct access to payers on the Avaneer Network
  • Data is shared directly between participants without third parties accessing or aggregating data
  • Coverage information is refreshed daily, and accurate updates are automatically pushed to participants
  • When coverage misalignment is identified, the solution:
    • Finds and resolves discrepancies in how different payers/provider represent coverage to avoid downstream problems like denials
    • Automatically updates the information in the source system as new data becomes available
  • Providers and payers are able to identify data issues early and remediate differences in patient/member information

Building on this new capability, we’re working on expanding Coverage DirectTM to include eligibility verification and patient estimation. With insight into the full benefit picture, we expect even more denials can be prevented, patient collections will be more streamlined, and the patient experience will be improved. In addition to our new eligibility and estimation solution, we are working on several other projects that we believe can reinvent some of healthcare’s most costly, inefficient administrative processes.

Stay tuned for more exciting news from Avaneer Health as we work to simplify the business of healthcare.

​​​​​​Matthew Blake
Senior Project Manager, Avaneer Health

In This Issue

From the Avaneer Podcast

The Spark: Transforming your IT infrastructure from a cost center to a strategic revenue contributor by focusing on patient-centric digital tools

With the advent of consumerism, patients are now the primary driver of a healthcare organization’s revenues. In this insightful podcast, Michael Archuleta, CIO at Mount San Raphael Hospital Trinidad, Colorado, explains how any hospital can transform its IT infrastructure from a cost center to a strategic revenue contributor by building asynchronous digital tools that benefit patients both inside and outside the organization.

Listen to the podcast

The Spark: Envisioning a more connected, collaborative future

In this podcast, Seth Joseph, founder and managing director of Summit Health Advisors and contributor at Forbes, explains why he believes companies like Slack, Airbnb, and Uber hold the answer to solving some of healthcare’s most pressing challenges. He also shares why government mandates often get in the way of healthcare innovation by driving a focus on regulatory compliance instead of on solving specific clinical and administrative problems.

Listen to the podcast

The 5 pillars of healthcare innovation

Ryan Howells, principal at Leavitt Partners and Program Manager at CARIN Alliance, and Jason Sherwin , senior director of Healthcare Business Development at CLEAR, discuss what healthcare will look like in the coming decade. They also share the five pillars of healthcare innovation and the three essential technologies that will drive equity, accessibility, and “micro experiences” for patients and providers.

Listen to the podcast

Industry Highlights

Lower reimbursement rates, denials behind razor-thin margins

RevCycle Intelligence

Hospitals continue struggling with labor shortages and historically low operating margins. Healthcare Financial Management Association and Eliciting Insights recently surveyed more than 130 health system CFOs about their greatest challenges. Eighty-four percent said lower payer reimbursement rates—driven by increased denials—are the top cause of their struggling operating margins. Learn what hospital leaders are doing to address denials and create financial viability.

Read more

What ‘Digital Transformation’ Means to 3 Health System Execs

MedCity News

During the recent HIMSS conference, three health leaders shared their thoughts on the value of digital transformation and how they’re employing AI to drive the transformation in their organizations. Learn about their challenges and the strategies they’re implementing in this insightful blog.

Read more

From the Avaneer Blog

Getting Coverage Right Takes a Team Approach

The idea of payers and providers working seamlessly together may seem unfathomable. Fortunately, that is no longer the case. We now have innovative new technologies that eliminate the issues of transparency and clear a pathway for mutually beneficial collaboration. This team approach puts the patient at the center and helps lower costs and create greater financial viability.

Read the blog

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