Clover Health Continues to Invest in Streamlining Provider Workflows and Reducing Administrative Burden Through Technology and Operational Improvements

Clover Health Investments, Corp., a physician enablement company dedicated to bringing access to great healthcare to everyone on Medicare, is leveraging Availity, the nation’s largest real-time health information network, for a multi-phase initiative designed to increase operational efficiency across administrative functions for providers while improving patient access to timely, quality care.

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Across the healthcare system, providers face significant challenges managing prior authorizations, eligibility checks, and claims. These processes can take the focus away from patient care and create unnecessary administrative burden that can delay treatment and impact patient outcomes. As part of Clover’s strategic commitment to operational excellence, the Company is investing in solutions that directly address these challenges while ensuring providers know their voices are heard and valued in shaping these improvements.

Key Enhancements

  • Centralized Access: A single, highly secure interface that allows providers to manage core administrative tasks across multiple health plans. This streamlined access means providers can spend more time with patients and less time navigating multiple systems.
  • Streamlined Prior Authorizations: Faster, more efficient approval workflows designed to reduce delays in patient care.
  • Real-Time Transparency: Tools for instant eligibility verification and advanced claims tracking, giving providers the information they need when they need it.

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“Providers have been clear – they need less red tape and more support in focusing on patients,” said Jamie Reynoso, CEO of Medicare Advantage at Clover Health. “This new portal is one of several steps we’re taking to ease administrative burden, accelerate decision-making, and vdeliver on our commitment to a more efficient provider experience, empowering them to focus on what they do best: delivering high quality care to their patients, faster.”

This collaboration is enabled by Availity’s position as the nation’s largest dual-sided network in healthcare, including 3.4 million providers, thousands of health IT vendors, and direct connectivity to more than 95 percent of health plans.

The new portal will be implemented in phases to ensure optimal performance and provider experience while minimizing any disruption to patient care. Clover is currently partnering with pilot providers to refine the system before expanding access across its full provider network.

“Clover Health’s rollout of our Availity Essentials demonstrates how health plans and providers can work together through Availity’s dual-sided network to reduce friction and deliver measurable value,” said Russ Thomas, CEO of Availity. “This collaboration reflects our vision for empowering stakeholders to make better decisions, experiences, interoperability, and scale in service of improving patient outcomes.”

This rollout builds on Clover Health’s ongoing strategic initiatives to make working with the Company more efficient and less complex while improving the member experience, including:

  • Reducing the number of procedure codes requiring authorization, focusing only on areas with the highest potential for fraud, waste, or abuse.
  • Expanding electronic submissions underpinned by clinician reviews, with a majority of prior authorizations now processed digitally and more approved instantly. This enables providers to receive immediate feedback and proceed with patient care without delays, reducing administrative overhead.

Looking ahead, Clover is committed to working with providers and CMS to further accelerate prior authorization electronic submission adoption through standardized data and submission elements (using FHIR APIs), expand real-time coverage determinations, and enhance determination transparency. This past month, Clover Health signed on as a CMS-Aligned Network early adopter, pledging to work collaboratively to enable the CMS Interoperability Framework goals and confirming Clover’s belief in a future where seamless care coordination and data-sharing for the patients’ needs are the norm, not the exception.

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Source – GlobeNewswire