Insurance Technology Featured Article

Optum and Availity Partner to Streamline Claims Submission Process

By Rory Lidstone
Contributing Writer

Optum and Availity, two major names in the health services business, recently entered into a new partnership that promises to help improve the completeness and accuracy of health insurance claims, while reducing claims processing errors and appeals. The collaboration will affect more than 900,000 care providers that use practice management systems to exchange real-time administrative, financial and clinical information with government and commercial health plans via the Availity Health Information Network.

Availity plans to implement Optum’s Advanced Claim Editing (ACE) solution as a component within the Availity Health Information Network. By leveraging Optum’s ACE solution, participating health plans will be able to give care providers timely notifications and feedback on actionable errors and information gaps that may result in claim denials.

The result is that care providers will be more likely to submit accurately completed claims, enabling health plans to reduce claims processing times and mitigate appeals and the costly investigation and recovery efforts that go along with them.

“Availity’s rich feature set and extensive network of care providers and health plans is an ideal home for Optum’s ACE solution,” said Russ Thomas, CEO of Availity. “Availity offers a single point of engagement for health plans and care providers, which leads to improved payment turnaround and more accurate claims submissions. We are delighted to have been selected by Optum to connect its industry-leading ACE solution to our broad national network of health plans.”

Also as part of this partnership, Optum will now use the Availity Health Information Network to connect to commercial and government health plans across the country. As a result, Optum will move a significant number of its third-party commercial and government transactions to the network, increasing Availity’s scope from two billion to over three billion transactions each year.

“By streamlining the claims process for health plans and care providers, ACE can take unnecessary cost and friction out of the health system, while improving patient experiences,” said Bill Miller (News - Alert), CEO of OptumInsight.