Availity Demonstrates Industry Shift from Denial Management to Prevention with New Resource

JACKSONVILLE, Fla.--(BUSINESS WIRE)--Availity, the nation's largest health information network, today announced the release of its latest industry resource, “A Guide to Preventing Denials and Protecting Revenue.” The new eBook is designed to help providers move beyond back-end denial management and adopt a more proactive, connected approach to denial prevention.

"With the right data, connectivity, and AI-driven insights, providers can prevent issues before submission, improve clean claim rates, and significantly reduce administrative burden."

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As claim denials continue to place operational and financial pressure on healthcare organizations, Availity is helping define the next era of revenue cycle management: one where providers use better data, payer connectivity, and predictive intelligence to prevent avoidable denials before they disrupt cash flow, staff capacity, and patient experience.

According to the recent Availity Abrasion Index, 90% of providers and 87% of payers view denials as a major abrasion point. Many denials are due to inaccurate data or submissions and could be addressed earlier in the administrative process. While approximately 70% of denied claims are eventually overturned, the appeals process is costly at $57.23 per claim in 2023. Collectively, this underscores the growing administrative and financial challenges impacting revenue cycle teams.

Denials are no longer simply a back-office reimbursement issue. They are a systemic workflow challenge tied to data quality, payer connectivity, administrative complexity, and the ability to act before a claim is submitted.

“Claim denials are one of the most persistent and costly challenges in healthcare revenue cycle management,” said Russ Thomas, CEO of Availity. “With the right data, connectivity, and AI-driven insights, providers can prevent issues before submission, improve clean claim rates, and significantly reduce administrative burden. That is where the industry needs to move—from reacting to denials after the fact to preventing them upstream through connected, real-time information exchange.”

Why are claim denials increasing?

Increased denials can often be attributed to inconsistent data quality, complex payer rules and lack of real-time payer connectivity, which drive nearly half of all denials. As denial rates continue to climb, providers face increasing operational strain and financial risk. Recent analysis shows that between 38% and 41% of providers report denial rates at or above 10%. Compounding this is the fact that 89-90% of denials involve manual review or intervention, which delays care and costs payers and providers time and money.

In addition, consider that:

• Nearly 90% of revenue cycle leaders report increased payer requests and appeals, adding significant administrative burden.
• 77% of providers say payer rules are changing more frequently, complicating compliance and workflows.

These pressures point to a broader industry reality: denial prevention cannot be solved through manual rework alone. Providers need connected workflows that identify risk earlier, surface actionable insights, and reduce avoidable friction across the revenue cycle.

How does Availity recommend healthcare organizations address denials?

Availity recommends healthcare organizations adopt a modern, proactive approach to denial prevention. Key strategies include:

• Strengthening pre-submission workflows
• Leveraging AI to identify high-risk claims before submission
• Implementing real-time payer connectivity
• Using integrated workflows and automation connected workflows that reduce manual work and help teams act earlier

Organizations that adopt predictive, data-driven approaches can prevent up to 35% of avoidable denials, achieve up to 98% precision in identifying high-risk claims, and realize estimated annual savings exceeding $1.7 million.

For providers, the opportunity is not simply to appeal more efficiently. It is to build an operating model that reduces avoidable denials at the source—before claims reach the payer and before staff time is consumed by rework.

What technologies or tools can help prevent denials?

There are an increasing number of AI-powered tools that reduce manual rework. Research shows that 67% of providers believe these tools can improve claims processing, but only 14% have adopted these models.

To effectively leverage any AI tool, providers will need a platform that offers end-to-end integration, real-time payer connectivity, and predictive intelligence. Availity can help deliver these capabilities through its real-time payer network, intelligent claim editing, and predictive analytics, enabling providers to identify high-risk claims before submission and streamline workflows across the revenue cycle.

Availity’s position in the market is distinct because denial prevention depends on more than a single tool. It requires payer connectivity, claims intelligence, workflow integration, and the scale to identify patterns across a broad network. As the nation’s largest health information network, Availity helps providers move from disconnected denial interventions to a more connected, upstream prevention model.

How can providers learn more about the denials prevention eBook?

Download the eBook: “A Guide to Preventing Denials and Protecting Revenue”

Availity will be at the Healthcare Financial Management Annual Conference in National Harbor, Maryland this week at booth #443 to discuss end-to-end revenue cycle solutions, including new innovations designed to help providers reduce avoidable denials, improve workflow efficiency, and gain clearer insight into revenue cycle performance.

About Availity

Availity empowers payers and providers to deliver transformative patient experiences by enabling the seamless exchange of clinical, administrative, and financial information. As the nation's largest real-time health information network, Availity develops intelligent, automated, and interoperable solutions that foster collaboration and shared value across the healthcare ecosystem. With connections to over 95% of payers, more than 3 million providers, and over 2,000 trading partners, Availity provides mission-critical connectivity to drive the future of healthcare innovation. For more information, including an online demonstration, please visit www.availity.com or call 1.800.AVAILITY (282.4548). Follow us on LinkedIn.