JACKSONVILLE, Florida — Jul 29, 2026
Executive Summary
Availity has released a new eBook, “Why Payment Accuracy Is the Next Operating Model for Payment Integrity,” encouraging healthcare organizations to prevent claim errors before submission rather than correcting them afterward. The resource outlines how payment accuracy, AI-driven insights, and upstream workflows can reduce administrative burden, minimize claims rework, improve payment predictability, and strengthen the healthcare revenue cycle.
Announcement Overview
Availity, the nation’s largest health information network, has unveiled a new eBook explaining why healthcare organizations should transition from traditional payment integrity practices toward payment accuracy. Drawing on findings from the 2026 Availity Abrasion Index, the publication highlights growing operational friction caused by downstream claims correction and presents an upstream model that applies payer guidance before claims are submitted. The resource also explores the role of artificial intelligence, real-time claims intelligence, and payer-provider collaboration in improving operational efficiency, reducing costs, and creating a more predictable reimbursement process.
Key Announcement Details
- Announcement Type: Product / Industry Resource Launch
- Announcing Entity: Availity
- Announcement Date: Jul 29, 2026
- Dateline: JACKSONVILLE, Fla.
- Industry: Healthcare Technology
- Primary Focus: Upstream payment accuracy
- Target Audience: Healthcare payers and providers
- Core Objective: Prevent claim errors before submission
- Industry Insight: Based on the 2026 Availity Abrasion Index
- Operational Challenge: Administrative burden and claims rework
- Proposed Model: Shift from downstream correction to upstream prevention
- Key Benefits: Lower costs, faster payments, improved predictability
- AI Role: Denial prevention and claims optimization
- Workflow Integration: Real-time payer guidance before claim submission
- Payment Integrity Role: Focus on complex claims and fraud detection
- Availity Capabilities: Claims intelligence, predictive analytics, payer connectivity
- Network Scale: 95%+ of payers, 3M+ providers, 2,000+ trading partners
- Resource Availability: Downloadable eBook
- Company Website: www.availity.com
Why Payment Accuracy Is the Next Operating Model for Payment Integrity
Availity’s latest eBook is designed to help healthcare organizations rethink how payment issues are managed throughout the revenue cycle. Rather than relying primarily on post-payment reviews and corrective actions, the publication advocates preventing avoidable claim issues before they enter payer workflows.
According to Availity, this approach can help organizations:
- Reduce downstream claims rework.
- Lower administrative burden.
- Improve payment predictability.
- Accelerate revenue cycle efficiency.
- Decrease payer-provider friction.
- Support a better member experience by reducing confusion and unexpected billing.
Industry Findings Highlight Growing Operational Friction
The eBook references findings from the 2026 Availity Abrasion Index, which identified payment integrity as one of the three most significant sources of operational friction across the healthcare ecosystem.
Key findings include:
- 64% of providers rated payment integrity challenges 4 or higher out of 5.
- 70% of payers also rated payment integrity 4 or higher out of 5.
- Current payment integrity practices can:
- Delay cash flow.
- Increase administrative work.
- Create long-tail recoupment risks.
- Add friction between payers and providers.
The publication notes that rising administrative costs, increasing denials, expanding post-payment recovery efforts, and ongoing payer-provider abrasion reinforce the need for a more preventive operating model.
Company Commentary
Russ Thomas, Chief Executive Officer, Availity, said:
“Appropriate and accurate payment is essential for every healthcare organization.”
He added:
“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.”
What Is the Difference Between Payment Integrity and Payment Accuracy?
The eBook distinguishes between the objectives of payment integrity and the operating model proposed through payment accuracy.
Payment Integrity
Payment integrity is intended to ensure claims are:
- Legitimate.
- Medically necessary.
- Financially appropriate.
However, the publication explains that many existing payment integrity programs rely heavily on:
- Post-payment recovery.
- Retrospective reviews.
- Lookback processes.
Availity states that these approaches consume significant operational resources.
According to the eBook:
- Approximately $25 billion is spent annually on claims adjudication.
- Around $18 billion is associated with reworked claims that are ultimately paid.
Payment Accuracy
Payment accuracy moves claim review earlier in the revenue cycle by applying administrative, clinical, and payer-policy guidance before claims are created.
Benefits highlighted include:
- Identifying avoidable issues in real time.
- Reducing downstream rework.
- Allowing payment integrity teams to concentrate on complex claims.
- Improving efficiency across payer and provider organizations.
What Does a Mature Payment Accuracy Model Look Like?
Availity describes a mature payment accuracy model as one that identifies common issues before claims are submitted.
The model embeds:
- Payer-managed rules.
- Clinical logic.
- Policy guidance.
These capabilities operate directly within provider claim submission workflows and can identify:
- Eligibility issues.
- Coding mismatches.
- Contract misalignment.
- Documentation gaps.
By resolving these issues before claims reach payer systems, organizations can reduce payment delays and unnecessary administrative effort.
Why the Healthcare Industry Should Shift to Payment Accuracy
The publication emphasizes that payment integrity remains important for validating legitimate and appropriate claims, but argues that preventable issues should be addressed earlier in the process.
According to the eBook, shifting correction upstream can:
- Reduce administrative complexity.
- Lower operating costs.
- Minimize avoidable claims rework.
- Improve payment predictability.
- Reduce friction across the healthcare ecosystem.
- Give providers clearer guidance before claim submission.
- Allow providers to spend more time on patient care.
- Enable payment integrity teams to focus on higher-value work.
What Should Payment Integrity Teams Focus On?
Availity explains that successful payment accuracy programs enable payment integrity specialists to concentrate on activities requiring deeper expertise.
These include:
- Analyzing complex medical claims.
- Identifying fraud, waste, and abuse.
- Working with medical policy teams.
- Defining and enforcing appropriate payment rules.
What Role Does AI Play in Denial Prevention?
The eBook highlights artificial intelligence as an important capability for improving claims quality before submission.
AI can help organizations:
- Predict recurring sources of error earlier in the claims lifecycle.
- Deliver real-time, actionable guidance to providers.
- Identify recurring error patterns.
- Help teams prioritize operational improvements.
- Reduce avoidable denials.
- Lower administrative burden at scale.
How Availity Supports Payment Accuracy
Availity states that its platform combines:
- Network scale.
- Payer connectivity.
- Claims intelligence.
- Predictive analytics.
These capabilities support real-time exchange across:
- Eligibility.
- Authorizations.
- Claims.
- Clinical information.
- Additional administrative workflows.
According to the company, this network enables payers and providers to access insights that can reduce operational abrasion and improve collaboration.
Where Healthcare Leaders Can Learn More
Healthcare organizations interested in the payment accuracy model can download Availity’s eBook:
“Why Payment Accuracy Is the Next Operating Model for Payment Integrity.”
About Availity
Availity enables the exchange of clinical, administrative, and financial information between payers and providers to support improved patient experiences. As the nation’s largest real-time health information network, the company develops automated and interoperable solutions that promote collaboration across the healthcare ecosystem.
According to the company, its network includes:
- Connections with more than 95% of payers.
- More than 3 million providers.
- Over 2,000 trading partners.
Availity states that these capabilities provide mission-critical connectivity supporting continued healthcare innovation.
Media Contact
For additional information, visit availity.com.
Source Attribution
Source: Company announcement
