Availity launched its newest industry eBook, titled “Why Payment Accuracy Is the Next Operating Model for Payment Integrity,” today. The nation’s largest health information network designed this educational resource to help organizations eliminate claims rework. By shifting focus from reactive error corrections to proactive prevention, healthcare leaders can build a far more effective revenue cycle.
Industry data highlights an urgent need for change across the sector. According to the 2026 Availity Abrasion Index, traditional Payment Integrity ranks among the top three sources of friction for both payers and healthcare providers. In fact, 64 percent of providers and 70 percent of payers rate these processes as high-friction operations. Consequently, current retrospective reviews delay cash flows, inflate administrative expenses, and create long-tail recoupment risks.
Furthermore, the healthcare sector spends an estimated $25 billion annually on claims adjudication. Alarmingly, $18 billion of that total stems directly from reworking claims that health plans ultimately pay. Therefore, evolving standard Payment Integrity into upstream payment accuracy allows organizations to resolve preventable errors before claims ever reach payer systems.
“Appropriate and accurate payment is essential for every healthcare organization,” said Russ Thomas, CEO of Availity. “Too much effort is spent correcting payment issues after they have already created administrative burden for payers and providers. As an industry, we must shift work upstream so providers have clearer guidance earlier in the revenue cycle and payment integrity teams can focus on the complex cases where they deliver the greatest value.”
Upstream Prevention and Advanced AI Capabilities
A mature payment accuracy framework embeds clinical logic, contract rules, and policy guidance directly into existing provider workflows. As a result, the model identifies eligibility mismatches, coding errors, and documentation gaps in real time. This proactive approach enables instant corrections prior to claim submission. This frees up existing Payment Integrity teams to concentrate on higher-value initiatives. Key tasks include investigating complex medical claims, fraud, waste, and abuse prevention, and enhancing clinical policies.
In addition, artificial intelligence is critical in preventing claim denials at scale. Advanced AI tools can forecast recurring error patterns at the start of the claims life cycle. Also, AI gives real-time, actionable guidance to billing teams and helps staff prioritize fixing system issues.
Ultimately, Availity leverages network scale, claims intelligence, and predictive analytics to optimize real-time data exchanges. Through comprehensive Payment Integrity modernization, Availity is helping to lower costs, improve payment predictability and reduce industry friction.
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News Source: Businesswire.com
