ACE Helps Providers Submit Cleaner Claims Pre-Adjudication



The video starts by introducing the well-known adage that experienced carpenters always measure twice and cut once in order to save time, eliminate waste, and ensure good craftsmanship. In healthcare, providers and health plans are so busy that the idea of “measuring twice” seems like a luxury. In the video, we illustrate those factors that contribute to this: changing regulatory and compliance requirements, limited self-service tools, and a costly feedback cycle.

How do these factors affect providers? They have to deal with frustration, back-office work, and delayed reimbursement. For health plans, they have to deal with claims that are coded incorrectly, overpayments, missing risk adjustment data, and increased operating costs.

The video then transitions to how Availity’s Advanced Claims Editor, also known as ACE, can help solve these problems for providers and health plans. It does this by editing claims pre-receipt before they are received by the health plan. ACE combines a best-in-industry knowledgebase with a customizable rules engine that’s integrated into Availity’s platform.

The video goes on to discuss some of the specific features of ACE, including editing claims at the line item and allows providers to fix claims before the health plan receives them. The video concludes by stating that with ACE, health plans can achieve greater savings and improve provider satisfaction.

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