Avaneer Coverage Direct™ is a solution designed to provide healthcare payers and providers with accurate, real-time insurance coverage information. By facilitating direct, peer-to-peer data sharing without third-party involvement, it addresses common issues such as incomplete or incorrect coverage data, which often lead to claim denials and administrative inefficiencies. This proactive approach ensures that both payers and providers have the most up-to-date coverage information, enhancing operational efficiency and improving the patient experience. Key Features and Functionality: - Real-Time Data Sharing: Enables direct exchange of coverage information between payers and providers, eliminating the need for intermediaries. - Data Normalization: Converts various data formats into a standardized FHIR (Fast Healthcare Interoperability Resources format for consistency. - Patient/Member Matching: Identifies and resolves coverage misalignments by matching patient and member data across systems. - Error Identification: Detects missing, conflicting, inactive, incorrect, or invalid coverage information. - System Integration: Exports updated coverage data back into Electronic Health Records (EHR or preferred systems. - Analytics Dashboard: Provides a user-friendly interface for reviewing and addressing coverage discrepancies. Primary Value and Problem Solved: Avaneer Coverage Direct™ addresses the critical issue of inaccurate or outdated insurance coverage information, which is a leading cause of first-pass claim denials—accounting for at least 20% of such denials. By ensuring that coverage data is accurate and current, the solution reduces administrative burdens, lowers operational costs, and enhances the patient financial experience. For payers, it streamlines the discovery of Coordination of Benefits (COB leads and reduces recovery costs. For providers, it minimizes claim denials, decreases write-offs, and eliminates the need for retroactive prior authorizations, leading to a more efficient revenue cycle and improved patient satisfaction.