Avaneer Health has announced the launch of Avaneer Coverage Direct™, a solution designed to provide real-time health insurance coverage information for healthcare payers and providers. Utilizing a secure, peer-to-peer network, this service aims to reduce operational costs and enhance the patient experience.

Accurate coverage information is crucial for efficiently managing claims, avoiding denials, and ensuring timely provider reimbursements.

Traditionally, providers have relied on multiple electronic data interchange (EDI) transactions, manual processes, and retrospective analytics with limited discovery capabilities. Avaneer Health's new approach connects payers and providers directly to its decentralized network, offering real-time updates and a comprehensive view of active, inactive, and upcoming coverage, including any new or secondary coverage available.

"Avaneer Coverage Direct provides both care providers and payers with the latest, most accurate coverage information directly in their source systems," says , CEO of Avaneer Health.

"This enhanced insight benefits both parties and improves the patient financial experience. It's the first of many solutions aimed at reducing the cost and complexity of healthcare."

Cleveland Clinic, the initial pilot participant for Avaneer Coverage Direct, aims to use this solution to eliminate care delays and improve accuracy in patient financial responsibility by accessing precise coverage information upfront.

"Collaborating with Avaneer Health since its inception to improve the patient and caregiver experience. Through near real-time data exchange, we expect fewer discrepancies between covered services and those offered by providers, thereby reducing administrative overhead for both payers and providers.

Excited to see the transformative impact on reducing administrative burdens and enhancing patient experience,” says Chief Financial Officer at Cleveland Clinic. "This initiative supports our goal of delivering the highest level of patient experience while improving financial performance and efficiency."

Hanson also highlights the cost-saving potential of Avaneer Coverage Direct for both payers and providers. "Providers could save between $3.35 to $5.75 per claim, while payers could save up to $1.65 per claim," he says. "Providers benefit from reduced manual verification, fewer denied claims, fewer claim write-offs, and fewer retroactive prior authorizations.

Payers benefit from more streamlined adjudication, earlier coordination of benefits data, reduced call center volumes, and lower recovery costs."

By connecting to the Avaneer Network™, payers and providers can submit data to a secure cloud environment where it is accessible only to designated trading partners based on permissions set by each organization.

Data remains under the control of its original owner. When new or updated member/patient data is added, Avaneer Coverage Direct automatically identifies and resolves missing, conflicting, or incorrect details, facilitating direct information exchange among participants.

 

Source: avaneerhealth.com

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