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Key takeaways: Claim scrubbing is a critical part of claims management, designed to improve claim accuracy and catch errors before submission. Errors on claims are a leading cause for denials and reworks are costly and time-consuming. Organizations that adopt claim scrubber software, like Experian Health’s Claim Scrubber, typically see few denied claims and maximize reimbursements. Preventing claims denials is a top priority for 82% of healthcare organizations. Claim denial rates are climbing, and 68% of providers say submitting "clean claims" is more challenging than a year ago, per the latest Experian Health’s State of Claims 2025 data. Claim scrubber technology, like Experian Health's Claim Scrubber, can help healthcare providers submit clean claims from the start. Here’s what healthcare organizations need to know about using claim scrubbers to catch errors up front, minimize costly reworks and speed up reimbursements. What is claim scrubbing in healthcare? Claims scrubbing in healthcare is the process used by providers to increase claim accuracy and reduce errors, so that "clean claims" are submitted for reimbursement. Claim scrubbing is a critical part of the healthcare revenue cycle and a key component of an organization's overall claims management process. To minimize the risk of denials and costly rework, administrative staff typically review claims for accuracy before submission. Several areas of each claim are inspected and updated as needed, including patient information, coding, payer requirements and billing details. Why are claim scrubbers important? Claim scrubbers are important tools for healthcare organizations and are used to help teams submit clean and accurate claims the first time. These tools significantly limit the chance of a mistake slipping through due to human error or outdated information. With claim scrubbers, undercharges and denials are reduced; billing and payments are more timely; and providers see improved cash flow. Experian Health's Claim Scrubber, for instance, not only reduces the amount of claims errors but also streamlines the entire claim scrubbing process through automation. Claim Scrubber is built to seamlessly complement Experian Health's other claims processing solutions, including ClaimSource® and Denial Workflow Manager. Case study: Experian Health & State of Franklin Healthcare Associates See how State of Franklin Healthcare Associates used Claim Scrubber to expedite accounts receivable by 13% and reduce full-time employee requirements even as claims volume grew. What errors does a claim scrubber catch? Claim scrubbers are designed to identify and correct mistakes that may potentially lead to a denial. Missing claims data is the top reason a claim is denied, and more than a quarter of denials result from inaccurate or incomplete data collected at patient intake. A claim scrubber uses technology to cross-check claims for accuracy and to verify that all information is not only correct, but complete before submission. For example, Experian Health's Claim Scrubber solution uses automation to catch potential issues, like insurance information errors and billing code mistakes, before claims reach the payer. What's the difference between a claim scrubber and denial management software? A claim scrubber is designed to catch errors on claims before they are submitted, to make sure all information is accurate and complete. On the other hand, denial management software, such as Experian Health's Denial Workflow Manager, is used by providers to manage denied claims after they are submitted.  As technology evolves, organizations are also rapidly adopting new denial management solutions that leverage artificial intelligence (AI) to prevent denied claims before they start and process denials more efficiently.   On the front end, tools like Experian Health's Patient Access Curator™ (PAC) use AI to automatically check and verify patient demographic information such as insurance details and eligibility. Experian Health's AI Advantage™ works across two key stages of denial management to predict claim outcomes mid-cycle and pushes urgent tasks to the front of the queue.   Together, PAC and AI Advantage form a closed-loop system that helps providers reduce denials, increase reimbursements and reduce administrative burden. Case study: Experian Health & OhioHealth See how OhioHealth cut denials by 42% with Patient Access Curator and solved claim errors at the source. How does Claim Scrubber work? Experian Health's Claim Scrubber is designed to consistently and reliably help healthcare staff produce clean and accurate claims that are more likely to be approved by payers. Claim scrubbing occurs within 2.7 to 3.0 seconds, ensuring speedy transaction processing that leads to faster reimbursements — even in batch mode. Claim Scrubber operates on a VPN connectivity feature that ensures secure and rapid responses for real-time integrations. And since the solution is an Experian Health cloud-based application, providers can reap Claim Scrubber's full benefits without the need for downtime, managing servers or regular maintenance. Here's a closer look at how Claim Scrubber works: Step 1: Claim Scrubber meticulously analyzes each line of every pre-claim to verify accurate coding and information before submission to the claims clearinghouse. Step 2: After completing the analysis, Claim Scrubber provides general and payer-relevant edits that pinpoint incorrect code combinations or other issues that could lead to claim denial. Step 3: Edits are stored within the Claim Scrubber portal and can be conveniently accessed by users from their PMS and HIS. Step 4: Reasons for flagging a claim are detailed, so users can make appropriate corrections before submission. (Users can make edits in alignment with payer policies, using Experian Health's comprehensive database of commercial payer policies and content.) Step 5: Claim Scrubber identifies when the billed amount is less than the payer-allowed amount, helping health systems catch and correct undercharges. How does Claim Scrubber help improve claims management? Experian Health's Claim Scrubber provides revenue cycle decision-makers and their teams with numerous benefits to help improve claims management. Optimizes claims processing by identifying potential coding and billing errors upfront. Ensures error-free claims submission to payers or clearinghouses. Prevents undercharges and underpayment. Increases first-time pass rates and prevents costly, time-consuming rework and rebilling that may result in a second rejection. Enables compliance with rapidly evolving price transparency rules by staying updated on coding variances. The bottom line: What can healthcare leaders expect for the future of claims scrubbing? Payer rules are rapidly evolving, along with industry regulations, and rising denial rates show no signs of receding. To keep up, it's imperative for revenue cycle leaders to submit the cleanest claims possible—the first time. With the right claims scrubbing technology in place, like Experian Health's Claim Scrubber, healthcare organizations will be better positioned to tackle the denial spiral head-on, boost cash flow and maximize revenue on every claim for years to come. See how Experian Health's Claim Scrubber is helping healthcare organizations submit clean, thorough claims and get paid faster and more accurately. Learn more Contact us

Challenge: Manual authorizations couldn't scale with demand Manual workflows were no match for MetroHealth's growing prior authorization demands. With more than 300,000 patients coming through the doors each year, staff at the MetroHealth system spent their days manually chasing requests and approvals through phone calls and payer portals. Without a reliable way to track approvals, denied authorizations were often discovered late, forcing staff to scramble for status updates. Teams were overwhelmed, appointments were pushed back and patients waited longer for the procedures they needed. As the workload grew, so did the risk of claim denials, leaving the organization to absorb preventable revenue loss alongside hefty administrative costs. MetroHealth needed a way to scale authorizations without adding more strain to its teams. Solution: Authorizations that run in the background, not on the phones Hiring was off the table, so MetroHealth sought a revenue cycle management partner that could handle their authorization volumes and reduce reliance on manual, time-consuming processes. Ideally, this would be a vendor with strong payer connections and proven automation technology. Experian Health met those needs with its Authorizations solution. Authorizations automates inquiry and submission, so staff don't have to drop what they're doing to move a request forward. When a physician places an order in Epic, the authorization process starts immediately. Automation captures payer details and submits the request in seconds, while posting real-time updates into the electronic health record. It only asks for input when needed, guiding users through dynamic work queues to focus their time on what matters. The system also communicates directly with connected payers, and staff gain visibility into the status of each authorization. A big draw was Experian Health's extensive connections with major payers and utilization management companies, including UnitedHealthcare, Aetna, Humana, Cigna, eviCore, AIM and NIA. Whatever the specialty, Authorizations routes requests to the correct payer partner, helping speed determinations and keep care on schedule. This enables MetroHealth to process a wide range of authorization types through a single workflow, eliminating the need to handle requests in separate channels. MetroHealth also benefits from Authorizations' Knowledgebase feature. Rather than guessing which procedures require authorization, staff can refer to a continually updated library of payer rule sets that Experian Health updates monthly. Custom rules can be added whenever an unusual requirement pops up. This gives the health system greater control and helps ensure requests are accurate the first time. Outcome: From firefighting authorizations to a predictable routine Here are a few wins from MetroHealth after they implemented Experian Health's Authorizations solution: Monthly authorization transactions increased by 173%, from 2,200 to 6,000. Teams now work 30 days ahead of scheduled services instead of just 14, an increase in 114% time available. Average time spent on each authorization request dropped from 10 minutes to just under 4 minutes. Follow-ups are 50% faster. Peer-to-peer reviews happen 4–5 days sooner. One of the biggest improvements was simply being able to take on more work. An authorization request that used to take around ten minutes now takes just under four, and follow-ups move 50% faster because status checks run in the background. Instead of spending their day retyping information or digging through portals, staff can focus on exceptions and cases that need more attention. The team is no longer constrained to a tight two-week window and can initiate authorizations 30 days before the scheduled service. Doubling the lead time in this way gives them some breathing space to manage cases proactively, rather than reacting at the last minute, and helps prevent denials and delays. Thanks to this extra capacity, the same team went from handling roughly 2,200 authorizations per month to about 6,000, allowing MetroHealth to support more service lines and higher patient volumes without hiring more staff. They can rely on the system to capture the required details and keep requests moving. On the clinical side, a 60% decrease in time spent on authorizations and faster peer-to-peer reviews means patients receive decisions sooner. Good news, too, for busy clinicians already working full schedules. How MetroHealth made authorizations manageable MetroHealth's experience shows that authorizations don't improve by squeezing more effort out of staff, but by creating time and capacity for teams to work efficiently. For the management team, progress came down to three things: Bringing the right people in from the start, so everyone was aligned on the workflow and goals. Making data easy to find, such as building CPT codes into the system instead of burying them in spreadsheets or printouts. Investing in training and ongoing communication so teams knew how to use the solution and could get the most from it. Learn more about how Experian Health's Authorizations solution helps reduce manual effort and keep care and cash flow on track. Learn more Contact us

Experian Health is very pleased to announce that we’ve been recognized as a Consistent High Performer for Contract Management & Analysis Software in the 2025 KLAS report.

Revenue cycle management (RCM) teams are facing a year of major change, with new regulations, tighter margins and the adoption of artificial intelligence (AI) increasing the pressure on workflows. This article outlines Experian Health’s five RCM predictions for 2026, along with tools to consider when building a resilient revenue cycle.

Hospitals that treat Medicaid patients should update their eligibility and billing systems now to prepare for the One Big Beautiful Bill Act (OBBBA), which will bring major changes to Medicaid.

Key takeaways: Providers see eligibility verification and patient access as top use cases, but are cautious about using AI for critical decision-making. Privacy, security, accuracy and cost are seen as the greatest barriers to AI adoption. Most providers expect AI use to keep growing, but agree that some level of human oversight will still be important. New statistics shared by Experian Health show that confidence in AI is growing steadily among healthcare providers, though many remain cautious about how and where it’s used. While 63% of providers have already introduced AI into their RCM workflows in some way, most reserve it for lower-risk tasks such as analysis and automation. Many are still testing the waters to see where AI can add value without compromising accuracy or security. Experian Health surveyed 200 healthcare decision-makers in October 2025 to gauge their feelings about AI. This article summarizes their views on AI adoption in healthcare, including the main barriers, top revenue cycle use cases, and predictions for the next few years. Infographic: The evolving role of AI in healthcare RCM While full trust in AI remains limited, especially for high-stakes decision-making, confidence is rising. How much do healthcare providers trust AI? Experian Health’s data suggests that providers are split between feeling confident about using AI and cautious about letting the technology make decisions on its own. Around four in ten survey respondents say they mostly or completely trust the technology. Three in ten describe their level of trust as moderate, while the remaining third say they trust it only slightly or not at all. These trust levels inform the type of tasks AI is used for. Most providers are comfortable using AI for automation and data analysis, but are hesitant to rely on it for higher-stakes decisions. Only 5% say they would trust AI to make critical decisions independently. Interestingly, hospitals appear to be more confident: half of this group say they mostly or completely trust AI, compared with 28% of other provider organizations. In a recent consultation response, the American Hospital Association stated that hospitals are already seeing AI make a “significant positive impact” in clinical care, noting that “AI tools hold tremendous potential in helping transform care delivery and address some of the administrative burdens that increase costs.” This experience may explain why they’re more comfortable moving ahead with AI in business operations, too. What are the biggest barriers to AI adoption in healthcare revenue cycle management? Concerns about data privacy and security are the top barrier to AI adoption, mentioned by half of the survey respondents. For 41%, accuracy is a sticking point, making it difficult to fully trust AI’s results. Although hospitals tend to be more confident in AI overall, their reasons for hesitating differ from other providers. Hospitals are more apprehensive about regulatory issues, with 26% listing this in their top three concerns compared with 21% of other organizations. On the flip side, they may have found more cost-effective ways to implement AI. Only 23% of hospitals see cost as a barrier compared with 39% of other providers. What areas of the revenue cycle would benefit most from AI? Catching errors early in the revenue cycle According to Experian Health’s data, providers think AI has its greatest impact at the front end of the revenue cycle. More than half (52%) put insurance eligibility and benefits verification in the top three opportunities. Patient scheduling and access follow at 45%, and 44% point to patient registration and data collection. Improving front-end processes is exactly what Patient Access Curator™ (PAC) is designed to do. Using AI and machine learning, it automatically verifies and updates patient insurance information with a single click. Improving data quality at this early stage reduces downstream errors and delays. Clarissa Riggins, Chief Product Officer at Experian Health, discussed the benefits of applying AI early in the revenue cycle in an interview with Medical Economics: “Much of [the denials burden] still comes down to friction in workflows and incomplete or inaccurate registration information at the point of entry,” she says. “Fix the problems at the start and that should address the claim situation toward the end.” Predicting and reducing denials Only 32% of survey respondents reported seeing claims submission and denial prevention as top opportunities for AI. This is somewhat surprising, given that 69% of those using AI reported seeing a reduction in denials and improved resubmission results, according to Experian Health’s State of Claims 2025 survey. This suggests there may be some untapped potential for AI in denial management. Tools like Experian Health's AI Advantage™ utilize advanced analytics and machine learning to identify denial risks earlier, predict outcomes more accurately, and recover revenue more efficiently, functioning as a complement to Patient Access Curator. See how AI Advantage predicts and prevents denials: How are healthcare organizations currently using AI? Currently, nearly two-thirds of providers say they are using AI in some way. Around 15% of providers have fully integrated it into their RCM operations. At the other end of the spectrum, 24% are still in the exploratory stages. For organizations that are not quite there yet, the following resources show the results that are possible: Case study: Experian Health & OhioHealth See how OhioHealth cut denials by 42% with Patient Access Curator by solving claim errors at the source. On-Demand webinar: Reimagining patient access Learn how AI and automation eliminate manual errors, reduce denials and unlock millions in recoverable revenue. How do providers see AI usage changing over the next few years? Most healthcare leaders expect AI adoption to keep growing over the next three to five years. For more than half, this comes with the caveat that human oversight will remain essential. A small number (6%) think progress could stall because of regulatory or trust issues. As adoption increases, providers will need to figure out the balance between autonomy and oversight. The most effective models will see AI and staff working together, with technology improving efficiency and giving teams more capacity to handle those complex, higher-stakes tasks. FAQs Where should healthcare organizations start if they are new to using AI in the revenue cycle? Clarissa Riggins recommends starting small by targeting specific processes where automation can make an immediate difference, such as eligibility verification or claim edits. Running an AI pilot in workflow is a good way to help teams build confidence in the technology and measure results before scaling up. Will AI replace staff in revenue cycle management? Experian Health’s data suggest providers see AI as a way to support, not replace, their teams. By taking on repetitive, data-heavy tasks, AI gives staff more time to focus on problem solving and higher-value work that requires human judgement. How can providers use AI responsibly while maintaining oversight? Successful adoption depends on clear governance, reliable data and staff-friendly interfaces. This means choosing tools that complement human decision-making and enhance oversight rather than remove it. Find out more about how Patient Access Curator and AI Advantage help providers use AI to drive stronger revenue cycle performance. Learn more Contact us

Automated prior authorization solutions streamline workflows, simplify management across payer systems and offer advanced features to reduce manual effort — helping providers minimize denials and improve overall efficiency.

Manual insurance eligibility checks are slow, error-prone and a leading cause of claim denials. Find out how automated insurance verification delivers real-time accuracy, fewer billing errors and faster reimbursements — helping providers protect revenue and improve patient care.

Denial management is the process of addressing why healthcare claims are rejected or denied, instead of resolving them after they occur. This article explores denial management strategies, why outdated processes fail and how AI-driven solutions can help reduce denials and streamline workflows.