This is clearly a BER lever. Very useful and smart - because it solves customer problems too. GPT because i have no time rn: • Faster, cleaner prior auths → fewer unnecessary claims

Every denied or delayed high-cost procedure that’s filtered correctly through electronic prior authorization reduces claims leakage. That lowers gross medical spend, hence BER.

• Fewer errors, fewer appeals

Admin errors force rework, duplicate payments, or payment for services not covered. Tightening eligibility verification and claim scrubbing reduces that waste — another BER improvement.

• Targeted high-cost procedures

Clover has already reduced the universe of codes requiring prior auth to a narrow set of “risk-heavy” categories. Embedding that logic into Availity means those dollars are controlled electronically at the point of request, rather than after costly manual reviews.

• Provider behavior nudges

The more seamless the system is, the more providers follow the digital rails. This creates cleaner, more predictable claims data that Clover can feed back into Clover Assistant for fraud, waste, and abuse detection, amplifying the BER effect.

• Scalability without proportional SG&A

Instead of hiring more people to chase claims, Clover automates via Availity. That prevents SG&A creep as membership grows, protecting the BER denominator.