Initial product launch reveals significant financial benefits for payers and providers
Oak Brook, IL, May 22, 2024 /PRNewswire/ — Avaneer Health, a decentralized digital network and platform for simplifying the business of healthcare, today announced that it has launched Avaneer Coverage Direct™ for healthcare payers and providers. Avaneer Coverage Direct proactively delivers accurate, real-time health insurance coverage information on a secure, peer-to-peer network of payers and providers, lowering operations and systems costs while enhancing the patient/member experience.
Current and accurate coverage information is vital for efficiently managing claims, avoiding denials, facilitating timely provider reimbursement, and minimizing unnecessary administrative complexities for consumers. Today, providers use multiple electronic data interchange (EDI) transactions with limited discovery capability, manual processes, and retrospective analytics. Avaneer Health takes a new and different approach. Payers and providers connect directly to Avaneer Health’s decentralized network where Avaneer Coverage Direct provides enhanced discovery and updates of insurance coverage information in near real-time. Further, the proactive updates provide a holistic view of active, inactive, and upcoming coverage, including new or secondary coverage when available.
“Avaneer Coverage Direct gives both the care provider and the payer confidence that they each have the latest and most accurate coverage information proactively available in their source systems,” says Stuart Hanson, CEO, Avaneer Health. Hanson continues, “This level of insight creates value for both payers and providers, while improving the patient financial experience. This is the first solution of many in development that are designed to uniquely reduce the cost and complexity of healthcare.”
Cleveland Clinic, the first Avaneer Coverage Direct provider pilot participant, is innovating to ensure that it has the most accurate coverage information upfront to eliminate delays in care and inaccurate patient financial responsibility.
“We’ve been working with Avaneer Health since inception to improve the patient and caregiver experience. Through a near real-time data exchange, the expectation is to see fewer discrepancies between what services are covered by the payer and what providers offer to the patient, resulting in a decrease in administrative overhead costs for both payers and providers. We are excited to see the transformative impact on reducing the administrative burden and enhancing the patient experience,” says Dennis Laraway, Chief Financial Officer at Cleveland Clinic. “The initiative aligns with our goal to provide the highest level of patient experience while also improving overall financial performance and efficiency.”
Hanson explains that Avaneer Coverage Direct can help improve the patient/member experience and transform the process for payers and providers to update and access the latest coverage information, which will unlock unprecedented cost savings for both payers and providers. “Avaneer Coverage Direct can deliver short-term, hard value of between $3.35 to $5.75 per claim for providers and up to $1.65 per claim for payers,” says Hanson. “Most provider savings come from reducing manual verification, preventing or reducing the need to rework denied claims, claim write-offs, and avoidable retroactive prior authorizations. Payer savings are from more streamlined adjudication, earlier data on coordination of benefits, reduced call center volumes, and lower recovery costs.”
With a single connection to the Avaneer Network™, payers and providers submit data to their secure cloud environment, where it becomes discoverable solely by their designated trading partners on the Avaneer Network, based on permissions set by each organization. Data remains under the control of the data owner or originator. When new data for a member/patient is added or current data updated, Avaneer Coverage Direct determines missing, conflicting, and incorrect details automatically, and enables participants to directly exchange information.
About Avaneer Health
Avaneer Health is a decentralized digital network and platform for simplifying the business of healthcare. Designed as a modern IT infrastructure for healthcare data sharing, Avaneer Health is breaking down the barriers and data silos to improve healthcare experiences, speed of care, and enabling applications that drive significant administrative savings. The Avaneer platform is cloud-based and FHIR native, enabling secure and permission-based, peer-to-peer access to other organizations with shared members/patients on the network. Avaneer Health was founded in 2020 by a consortium of industry leaders including Aetna, a CVS Health company; Elevance Health; Cleveland Clinic; Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC); Sentara Healthcare; The PNC Financial Services Group, Inc.; and Merative. These founding members remain engaged with the company and its mission to solve inefficiencies in the healthcare industry.
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