Problem Statement

Certain claims predictably draw an additional-information request once they reach the payer, and if the supporting records aren't already on file when the claim adjudicates, it pends or denies for missing documentation, kicking off an ADR response and all the rework, delay, and aging that comes with it. Submitting the records up front, through the payer portal at the time of billing, heads that off entirely, so the claim adjudicates clean on the first pass. Doing this manually across every at-risk claim is labor-intensive and easy to skip under volume, which is exactly when the preventable denials slip through.

Automation Solution

This automation compiles medical records and uploads them to Availity at the time of billing, prior to claim adjudication, to prevent additional-information denials.