Patient Access

When it comes to artificial intelligence (AI) usage in the healthcare industry, adoption is steadily gaining momentum as providers explore new ways to utilize this technology in their revenue cycle management (RCM) processes. While full trust in AI remains limited, especially for high-stakes decision-making, confidence is rising.   Privacy, security, and implementation costs continue to pose significant challenges. However, providers broadly agree that AI will become a cornerstone of healthcare RCM in the next few years, especially in areas like eligibility verification and patient access. Many also acknowledge that human oversight will remain essential, to ensure accuracy and trust.  In October 2025, Experian Health surveyed 200 healthcare decision-makers to better understand how much they trust AI for decision-making, their biggest barriers to adoption, and where the opportunities lie.    Here are the results: AI in healthcare RCM isn’t the future; it’s happening now. Learn how healthcare organizations are using Experian Health’s AI technology to streamline patient access and reduce claim denials. Learn more Contact us

Key takeaways: Efficient revenue cycle management is crucial to ensuring efficient hospital operations and building financial stability.   RCM technology solutions allow healthcare organizations to increase cash flow and improve operational efficiency across the entire revenue cycle.   Revenue cycle management tools from Experian Health utilize data-driven insights, automation and AI to optimize revenue cycles, while supporting compliance and regulatory needs.  The revenue cycle management market is projected to grow to $238B by 2030. Revenue cycle management is a critical process that ensures healthcare organizations maintain healthy cash flow and keep operations running smoothly. However, keeping the financial scales tipped in the right direction can be a never-ending challenge for revenue cycle leaders. As hospital profit margins remain tight, technology-based RCM solutions can help revenue cycle leaders stay ahead and maximize reimbursements. In this guide to revenue cycle management, providers will learn how to optimize revenue cycle processes at every stage of the patient journey. What is revenue cycle management (RCM) in healthcare? Revenue management in healthcare connects the financial and clinical aspects of patient care. The primary purpose of RCM is to help healthcare organizations ensure proper reimbursement and accurate, efficient billing and claims management processes. Seamless revenue cycle management also allows providers to maintain a solid financial foundation, a critical factor in boosting resilience during uncertain economic times.    Over the last few decades, RCM in healthcare has undergone numerous evolutions. Largely paper-based, manual processes have been replaced by sophisticated software-based systems and data-driven technology. As more organizations embrace the ongoing digital transformation of RCM in healthcare, processes now commonly include solutions that utilize machine learning, automation and artificial intelligence (AI). Leveraging technology boosts efficiencies, streamlines operations and allows organizations to see quicker reimbursement rates. However, despite these upsides, switching to new modern revenue cycle management systems isn’t always a priority for providers. Many healthcare organizations still partially rely on outdated and disjointed systems that can result in reimbursement delays and other snags in the revenue cycle. How the healthcare revenue cycle works A typical healthcare revenue cycle follows the step-by-step lifecycle of a patient encounter, known as the patient journey. Every touchpoint is an opportunity for revenue cycle teams to ensure that patients, payers and back-office teams have the information needed to expedite payment. Along with revenue cycle leaders, a wide range of healthcare staff are commonly involved in various administrative functions across the RCM cycle. Depending on the organization and how revenue cycle processes are set up, this may include front desk staff, scheduling teams, medical coders, billing staff and collections teams. While individual healthcare organizations often customize their exact RCM process, most revenue cycles are generally broken down into several key​​ phases of the patient journey: pre-visit, visit and post-visit. Each phase of the healthcare revenue cycle also has its own specific components, such as registration, claim submission and collections. Key stages of the revenue cycle process commonly include: Pre-visit: This phase includes all of the steps of the patient journey that happen before treatment, such as preregistration, patient registration, insurance verification and prior authorization.  Patient visit: The next phase includes revenue cycle activities related to the patient visit for treatment or services, such as documentation, coding and charge capture.   Patient post-visit: This phase includes the steps of the patient journey after care has been received, such as claims submission, collections, payment posting, and any necessary follow-up.   Detailed breakdown of each revenue cycle stage Successful healthcare revenue cycles consist of a series of stages. Each component of the RCM cycle is carefully designed to prevent revenue leaks and create a frictionless patient journey. Here’s a detailed breakdown of what happens during each revenue cycle ​​stage across the pre-visit, visit and post-visit phases of the patient journey: Patient registration: Gathers key patient information before service, including demographics, insurance, medical history and other personal details.  Eligibility and benefits: Verifies patient insurance coverage status, checks for additional or unknown coverage and provides transparent, accurate estimates prior to service. Data entry: Maintains accuracy of patient information data, verifying and protecting patient identities to ensure the right information is linked with the right patient. Prior authorizations: Determines if prior authorizations are needed before service, submitting payer requests as needed. Patient encounter: Adds information about the services a patient receives to the patient record, setting the stage for accurate coding and billing. Charge posting: Submits claims to relevant payers using the appropriate charge posting or charge entry process  — including a detailed breakdown of all services provided to the patient, patient information, history and insurance or payment plan status. Coding and billing: Checks payer codes for the services that have been delivered — using diagnostic (Dx) codes, place of service (POS) codes, current procedural terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes and others to determine payable amounts. Claims management: Submits claims and facilitates communication between providers and payers during the claims adjudication process, providing early intervention for denied claims and reworks as needed. Payer contract management: Ensures timely reimbursements — auditing payer performance, keeping track of changing requirements and identifying reimbursement discrepancies and patterns of non-reimbursement. Patient billing and collections: Bills patient for remaining amount owed after insurance reimbursement — collecting balances using in-house collections teams or outside collections agencies. ​​​Common challenges in revenue cycle management (RCM) To avoid escalating administrative costs and revenue leaks, teams must remain vigilant against challenges that disrupt the revenue cycle — including data errors, billing code mistakes, claims denials and payment delays. It can often be overwhelming for busy RCM leaders to sidestep obstacles. However, staying on top of challenges in revenue cycle management is critical to ensuring healthy cash flow and smooth-running daily operations.  Here’s a closer look at six common roadblocks RCM leaders need to keep tabs on: Incomplete documentation: Missing or outdated insurance information — and other missing or incorrect patient data — can lead to coding errors, claim denials and billing delays. Mistakes are most common when organizations use outdated manual processes, like paper forms. Coding errors: Mistakes made during billing code submissions — often due to error-prone manual processes or rapidly changing payer requirements — can lead to denials, delays and reworks. Claim denials: Claims denials are on the rise, leaving healthcare organizations to face potential hits to the bottom line from delayed or unpaid claims, while adding extra administrative burden for reworks. High days in accounts receivable: Collection delays are often a major roadblock in the revenue cycle — disrupting cash flow and potentially leading to extra administrative costs and bad debt.   Patient payment responsibility increases: Rising healthcare costs, including out-of-pocket expenses and high-deductible healthcare plans, put more financial burdens on today’s patients, leaving many struggling to pay their medical bills. Regulatory complexity: New price transparency regulations, implementation of the One Big Beautiful Bill Act, patient privacy safeguards under the Health Insurance Portability and Accountability Act (HIPAA), payer compliance changes and other rapidly evolving healthcare requirements can bottleneck revenue cycle processes and slow down reimbursements.  ​​​Strategies to improve healthcare revenue cycle performance Leaders tasked with improving healthcare revenue cycle performance can adopt RCM strategies that turn roadblocks into opportunities for growth. Here are five strategies to streamline RCM processes, boost performance and maximize revenue.  Implement automation Quick, accurate and efficient patient access processes are the foundation of healthy revenue cycles. Revenue cycle leaders should look at technology-forward solutions that leverage automation to boost efficiencies across all stages of the revenue cycle – from registration and scheduling to prior authorizations, claims processing and collections.  Utilize real-time eligibility checks Finding missing health insurance is critical to keeping revenue cycles on track. Real-time insurance eligibility verification allows providers to quickly confirm active coverage at any point in the revenue cycle, including additional coverage a patient may have forgotten.   Avoid solutions that require heavy staff training or certifications Revenue cycle management solutions that are easy to onboard and require little to no staff training or special certifications are often more efficient to implement and utilize — minimizing administrative costs and allowing busy staff to focus on other priorities.  Consider outsourcing vs. in-house billing Implementing tools that streamline key steps in the RCM process—like coding, claims submissions and collections—allows busy billing teams to maximize their time, save on administrative costs, accelerate collections, and avoid unnecessary outsourcing to third parties.  Choose the right metrics to ​​monitor Identifying and monitoring key revenue cycle performance indicators (KPIs) aligned to specific RCM priorities offers real-time insights into key stages across the revenue cycle — including patient access, collections, claims and contract management. Check out this guide to choosing the right key performance indicators for your revenue cycle dashboard to ensure the effective implementation of RCM ​​strategies. RCM in the era of modern technology and ​​AI Reimbursement delays commonly stem from error-prone manual revenue cycle processes. Overworked staff burdened by time-consuming administrative tasks related to RCM often further compound reimbursement issues. However, adopting solutions that utilize revenue cycle management automation, machine learning and AI allows healthcare organizations to overcome numerous pain points and ensure prompt reimbursement.   While constantly evolving, today’s top revenue cycle management technology often relies on:  Interoperability and data integration: Data-driven, turnkey revenue cycle management healthcare tools share data and function together seamlessly across the revenue cycle — using machine learning, automation and AI to constantly improve RCM.  Patient engagement tools and payment portals: AI-powered patient engagement tools and automated solutions improve patient access and accelerate collections rates.  Use of predictive analytics: Built-in predictive analytics offer actionable insights that improve patient access, claims processing, collections and other key areas of the revenue cycle.   Revenue cycle management case studies​​ Exact Sciences Ken Kubisty, VP of Revenue Cycle at Exact Sciences, shares how Experian Health’s Patient Access Curator helped their organization reduce claim denial errors and added $75 million in insurance company collections. Community Medical Centers Brandon Burnett, VP, Revenue Cycle at Community Medical Centers, shares how their organization partnered with Experian Health to implement AI Advantage™, which uses artificial intelligence to prevent and triage claims denials. Weill Cornell Medicine In a recent on-demand Webinar, we shared how Weill Cornell Medicine and Experian Health implemented a smarter collections strategy that delivered $15 million in recoveries using Collections Optimization Manager. Watch the on-demand webinar > How to choose the right RCM software or vendor Revenue cycle leaders who want to improve their organization’s RCM process often benefit from implementing RCM software or partnering with a vendor that specializes in healthcare revenue cycle digital solutions.   When choosing a solution, look for these key features: Patient access tools to improve registration, scheduling, estimates and payments. Insurance verification software with the ability to perform real-time eligibility checks and stay on top of ever-evolving regulations and payer policies. Claims management solutions that improve accuracy and efficiencies across claims submission and denials management processes. Collections software to streamline patient collections and reduce bad debt. Contract management tools to audit payer compliance against contract terms and maximize reimbursement rates. Data and analytics tools to monitor the revenue cycle, track key performance metrics and gain valuable insights. Questions to ask vendors Vetting vendors is critical to finding the best RCM software. Each healthcare organization has unique needs, so it’s important to vet vendors carefully to find the right revenue cycle management solutions.   Consider these questions when scoping out revenue cycle software solutions and vendors: Implementation: What’s the implementation process like? How does staff training and onboarding work?   Integration: Will the RCM software work with legacy systems? If not, what processes can it replace?   Customization: What types of customization options are available? What legacy systems are supported?   Scalability: How flexible is the solution? Does the RCM software have the ability to scale?   Usability: Is the software user-friendly? How easy is it to navigate the platform, share data and manage multiple stages of the revenue cycle?  Reporting: What types of reporting and analytics are built-in? Can KPIs be customized?   Cost: How does pricing work? Is it determined by functionality? Number of users? Size of organization?  Customer support: What type of customer support is available? Will the organization have a dedicated customer service representative? Are experts available to help customize the software for the organization's needs or analyze data? Build vs. buy decision-making Adopting technology to streamline revenue cycle management is often a large investment. Finding the best solution often comes down to the healthcare organization's unique needs, including budget, existing technology stack and other factors.   Ultimately, the tools chosen will have a significant impact on an organization’s financial and operational health, making the decision to build a custom solution or purchase turnkey RCM software a critical one. While there’s no “right” choice, revenue cycle leaders should consider the pros and cons and vet vendors carefully to help ensure long-term success. Why choose Experian Health for revenue cycle management​ Working with an industry-leading revenue cycle software solution partner, like Experian Health, allows healthcare organizations to modernize and speed up their entire revenue cycle management process. Experian Health offers a wide range of award-winning revenue cycle management tools that allow organizations to optimize every stage of the revenue cycle — from patient access to collections, claims management and payer contract management.   Robust automated solutions help organizations eliminate manual processes, submit cleaner claims, maximize collections and cash flow – all while staying compliant with the latest regulations and improving the patient experience at every stage of the journey. Experian Health’s built-in RCM analytics leverage data to analyze, track and further optimize performance. Turning revenue cycle roadblocks into opportunities for ​​growth Today’s healthcare revenue cycle leaders face more RCM obstacles than ever before — from increasingly complex billing processes and rising healthcare costs to frequent regulatory and payer requirements and staff shortages. However, providers also have unprecedented access to RCM technology solutions designed to streamline all stages of the revenue cycle management process. Healthcare organizations that embrace RCM software solutions – especially tools that use AI, automation and machine learning – can optimize revenue cycle management, boost overall financial resiliency and keep revenue flowing for many years to come.   Learn more about how Experian Health’s revenue cycle management solutions can help healthcare organizations generate more revenue and increase their bottom lines. Learn more Contact us

Healthcare claims denials are on the rise, despite more than a decade of industry-wide technological advances aimed at improving claims management processes. However, in recent years, the introduction of artificial intelligence (AI) into the healthcare ecosystem has begun transforming how healthcare organizations manage patient access — and the entire revenue cycle. The State of Claims: 2025 Download the full report to uncover actionable strategies and see if AI is what can break the denial cycle for your organization. This article summarizes a recent webinar with Experian Health’s Vice President of Innovation, David ‘Fig’ Figueredo, and Kate Ankumah, Product Manager for Patient Access Curator™, as they break down how healthcare organizations can use AI to build scalable, data-driven revenue cycle solutions and deliver measurable value across the patient access ecosystem. Explore how Experian Health is reshaping the way health systems manage Coordination of Benefits. Learn how automation and AI are eliminating manual errors, reducing denials and unlocking millions in recoverable revenue. Watch now > Evolution of AI in healthcare For more than a decade, a progression of technology – mostly rooted in automation – has attempted to solve the issue of rising denials. Today, with the help of AI solutions, the process is shifting away from transactional activities to a more intelligence-driven approach. AI tools can be implemented at every stage of the revenue cycle to solve persistent challenges – like benefit coordination, eligibility verification, and claims management. And while most providers have the capability to add AI solutions, claims denials continue to climb. “With all of the investment by organizations like Experian Health and HIS system vendors, there still is a high prevalence of an issue with coordination of benefits and eligibility denials.”David Figueredo, Experian Health’s VP of Innovation Figueredo further points out that while revenue cycle leaders are aware of AI and its potential, they often remain skeptical of the technology or are unsure how to best leverage AI tools for denial prevention. Overcoming perceptions about AI Healthcare leaders sometimes struggle with negative perceptions around adopting AI solutions. Figueredo notes this is common, and wants organizations to know that with AI, “There’s a lot of power, hope and expectation around the use of applied technologies and automation in the revenue cycle process.” Concerns about implementing AI for revenue cycle management vary widely. However, according to the results of an Experian Health data study presented during the webinar, "accuracy and reliability” are often a top worry among healthcare organizations considering adopting AI technology. Other common concerns about leveraging AI solutions include data privacy and security, cost of implementation, staff resistance and labor risk, and lack of transparency. Healthcare organizations also want to base the decision to utilize AI on measurable results. Where in the revenue cycle has AI been implemented? How did it improve denial rates? Finding a path forward with AI AI offers healthcare organizations the potential to increase operational efficiencies, reduce administrative burdens, and reduce costs. While many revenue cycle leaders are most willing to place bets on using AI for patient eligibility verification and claims management, barriers to adopting AI still exist. Figueredo notes: “We’re seeing a lot of organizations that are interested [in AI], but also guarded about its use. Healthcare leaders typically have a specific goal in mind for using AI and want to see real-world results.” He reminds healthcare leaders that with AI, we “can do things we couldn’t do before – but it’s how it’s applied in solving things in the [revenue cycle] process” that really matters. For many healthcare providers, the question becomes: Does adding AI solutions to the revenue cycle provide acceleration? Improve patient access? Reduce the number of manual touches? Can AI do more of the work consistently so staff labor can be reapplied to other focus areas? Does AI help mitigate ongoing staff shortages? Will it cut costs for healthcare organizations already operating on thin margins? Adopting AI: RCM best practices When modernizing the revenue cycle, Figueredo reminds healthcare providers to have a clear set of guidelines and recommends ensuring AI solutions are designed to meet specific revenue cycle goals. Top priorities for healthcare organizations often include: Reducing manual interactions: While there are still some situations that require human intelligence to make decisions, countless simple tasks can be automated to minimize manual workload. Fixing issues on the front end: Early interventions to proactively correct potential issues with claims before they become a bigger problem, like incorrect patient demographics or eligibility information, can be critical to preventing denials. Supporting real-time integration: To avoid relying on batch auditing or poorly informed automated decision-making in the revenue cycle, HIS systems and patient access platforms, like scheduling and billing, must be designed to handle real-time corrections. Adopting AI for COB with Experian Health’s Patient Access Curator Turnkey AI tools, like Experian’s Health’s Patient Access Curator (PAC), allow healthcare organizations to implement a comprehensive patient access COB solution that touches every step of the revenue cycle process – starting with patient registration. PAC consolidates important functions like eligibility checks, MBI, demographics and discovery into one seamless solution to maximize clean claims and minimize denials, appeals and resubmissions. Kate Ankumah, Product Manager for Experian Health’s Patient Access Curator, explains: “We know that bad data is like a virus. If it starts bad, it ends up on the claim – even if you try to solve it mid-stream, it’s already saved somewhere. At the point of scheduling, at the point of registration, [with the Patient Access Curator], we’re giving you the most accurate data so that it can live and get accurate to the claim." Case study: Experian Health and OhioHealth See how OhioHealth cut denials by 42% with Patient Access Curator and solved claim errors at the source. Benefits of leveraging AI for COB and claims management Adopting COB solutions powered by AI and machine-learning, like Experian Health’s Patient Access Curator, healthcare providers can improve overall accuracy during claims processing on the front end – and at every step of the revenue cycle. And when errors are reduced from the start, healthcare organizations typically benefit from less wasted staff time, decreased denial volumes, accelerated denial management, and fewer contingency vendor fees – plus a better patient experience overall. Patient Access Curator is available now – learn how your healthcare organization can get started and prevent claim denials in seconds. Learn more Contact us

"We knew we needed to transform our authorization workflow processes. We were experiencing a high rate of denials due to a lack of authorizations."- Amy Grissett, Senior Director of Ambulatory Revenue Cycle at USA Health Challenge: Manual processes that couldn't keep up Serving more than 250,000 patients each year across hospitals, specialty centers and outpatient clinics means USA Health processes hundreds of thousands of authorizations. Speed is critical. Unfortunately, small inefficiencies were taking a major toll. Frustrating manual authorization processes resulted in work queue errors, forcing staff to print schedules multiple times a day to keep track of changes. Inevitably, cases were missed, resulting in claim denials and delays. It was hard to see where to make improvements without a reliable way to monitor staff performance. As new service lines were added and authorization requests grew, USA Health needed to find a more efficient way of handling authorizations, or overworked teams would be under even more pressure. Amy Grissett, Senior Director of Ambulatory Revenue Cycle at USA Health, says, "We knew we needed to transform our authorization workflow processes. We were experiencing a high rate of denials due to a lack of authorizations." Since hiring extra staff had been ruled out, automated prior authorizations were the obvious solution. Solution: Automating authorizations for faster, more efficient workflows Having already worked with Experian Health for eligibility, USA Health decided to implement Authorizations to optimize their workflows and automation. Alicia Pickett, Senior Product Manager at Experian Health, explains how this partnership worked: "First, the team needed to determine if authorization was necessary. If so, they would complete the authorization on the payer's website. Experian Health's Authorizations would then track the status of the authorization, saving time on phone calls and web portals for pending cases. Once the authorization was obtained, our product would automatically post the status update into the EHR." Automating status inquiries this way meant staff no longer needed to chase information through phone calls and payer portals. Dynamic work queues and alerts would guide them to priority tasks, allowing them to work more efficiently and accurately. Most importantly, authorized services could be cleared without delay. The tool also compares authorized procedures to those actually performed and flags any variance, so staff can amend claims submissions and prevent denials. "The implementation process took approximately 6-8 months, and we did it in phases," Grissett explains. "We started with one service line. As the team became more comfortable, we added additional service lines. Overall, the implementation met our expectations. And the solution has greatly improved our authorizations process and workflows." Outcome: Authorizations up, denials down Since implementing Authorizations, USA Health has seen measurable improvements, including: Increased daily authorizations by 100% Cut manual work by 50% and reduced errors and denials Expanded to six service lines without increasing staff Provided accurate tracking of staff productivity Instead of relying on slow, manual processes, staff now have thirty dynamic work queues at their fingertips, helping them process 130,000 authorization requests each year. Thirty dynamic work queues organize tasks by date and service line in real time. With automated payer website checks now delivering instant updates for more than half of all accounts, they can focus on the smaller number of complex cases that need hands-on management. The impact on productivity is clear. With the new workflow in place, the average number of accounts completed per employee each day has more than doubled, from around 20 accounts to between 40 and 50. In addition to monitoring accuracy and denial rates, Authorizations' monthly scorecards make it easier to measure staff performance. Grissett says, "We were trying to do more with less. We also wanted to be able to monitor what our employees were doing and ensure they were accountable. The tools that Experian provides allow us to capture that data." All of this benefits patients, too: With automated prior authorizations, fewer appointments are canceled or rescheduled because of authorization delays, so patients don't have to wait for care. "The Experian team was instrumental in helping us pivot and develop specific workflows tailored to our needs. Together, we addressed missing payer connections and created knowledge-based rule sets to drive efficiencies. As we add new facilities or services, the process is fairly seamless. We already have the intel on the number of staff required to manage a specific number of accounts, the productivity measures needed and how to streamline processes. This allows us to replicate workflow processes and optimize operations effectively. In fact, we've added six more departments with our staff of 28." - Amy Grissett, Senior Director of Ambulatory Revenue Cycle at USA Health Looking ahead, the team plans to introduce more service lines and facilities while continuing to refine workflows and streamline processes. Find out more about how Experian Health's automated prior authorizations can help your healthcare organization boost productivity, reduce errors and prevent costly denials. Learn more Contact us

Healthcare organizations are facing a perfect storm: rising claim denials, evolving payer rules, and patients expecting providers to reduce error rates that impact patient billing accuracy. Artificial intelligence (AI) has raised the stakes, causing revenue cycle leaders to feel the pressure to modernize quickly. According to Experian Health's State of Claims 2025 survey, 73% of providers agree that claim denials are increasing, which is a clear signal that outdated processes cost providers millions. The top-ranked reasons for denials included coding errors, missing or inaccurate data, authorizations, and incomplete information, to name a few. And with only 14% of providers using some form of AI technology in their processes, the message is clear:  the opportunity is high to get more providers to embrace the technology and reap the benefits of smarter automation. To stay competitive and financially viable, healthcare organizations must embrace AI-driven innovation that improves data accuracy, streamlines workflows and proactively prevents revenue leakage. To explore how leading RCM companies are responding, we interviewed David Figueredo, Experian Health's VP of Innovation, to get a closer look at how we're helping healthcare organizations use AI to tackle these challenges head-on. Meet the Executive David Figueredo, VP of Innovation at Experian Health, has spent over 20 years driving transformation in healthcare finance. Known for blending tech-forward thinking with operational expertise, David is passionate about using AI to solve persistent challenges in revenue cycle management, especially around claim denials and data accuracy. He believes that healthcare innovation must be both purposeful and scalable. "We're not just chasing trends, and buzzwords do not functionally solve problems," he says. "By focusing on building systems that adapt to payer behaviors and addressing the labor costs and manual inefficiencies providers face today, we can deliver measurable improvements in financial performance." David is passionate about building tools that empower revenue cycle teams to work smarter, not harder. "We're not just layering tech on top of broken processes," he says. "We're redesigning the workflows themselves to intuitively account for these emerging AI capabilities and by doing so, we are finding ways to fundamentally change those processes." Q1: "David, let's start with the big picture. How are you and your team thinking about innovation in revenue cycle management right now?" David: "At Experian Health, innovation is a strategic imperative, and the core to everything we do. We're focused on solving revenue cycle pain points, especially around claims management and patient access by blending AI, automation, and data intelligence to streamline workflows. We're not just trying to overlay new tech on yesterday's processes; we're reimagining how revenue cycle teams will operate, to reduce manual touch points and increase automated decisioning. That means leveraging AI to automate repetitive tasks, enable earlier and continuous monitoring with timely corrections, and equipping teams with actionable workflows backed by trustworthy, transparent insights. We're also seeing a shift in mindset and attitudes around automation and applied AI. Innovation used to be a long-term goal that took years to see measurable outcomes. Now, it's a short-term mandate where the pace of progress needs to deliver value today and increased value tomorrow. Our clients expect to see and feel the progress now, not just the promise of value in years to come. That's why we've designed a modular solution that allows clients to deploy AI tools where they deliver the most immediate value, while also supporting more complex workflows and integrations for the future. This includes integrating intelligence to improve eligibility checks, coordination of benefits (COB) and identity functions, enhancing claim scrubbing processes with accurate denial prediction and prioritization, and strengthening financial decisions with better data modeling that builds trust. Innovation should be cross-functional. This means aligning product design with IT build processes to reduce deployment times and mitigate risks, incorporating operations teams to ensure the right problems are being addressed, and enabling finance teams to better understand how technology impacts primary and secondary revenue streams." Watch our on-demand webinar to learn how healthcare organizations are using AI to eliminate manual payer chaining, detect and correct coverage issues in real-time, and reduce claim denials. Watch now Q2: "AI is everywhere these days, but how are you actually using it to reduce claim denials and improve data accuracy?" David: "AI can be a game-changer, but there is more to solving problems than just applying new technology. According to Experian Health's State of Claims 2025 report, 41% of respondents say their claims are denied more than 10% of the time. And 54% agree that errors in claims are increasing. We have to be thoughtful in how and where we apply AI to improve learning on the fly, promote integrated decision support in real time and automate actioning so that highly skilled and limited staff can focus on higher-value functions. AI is not just about automation; it's about intelligent intervention applied to real problems, removing guesswork, early issue identification and eliminating missed steps to improve the overall yield of the revenue cycle. Consider the denial space, where billions in revenue are lost each year. While the causes of denials are very diverse, many of them are excellent opportunities for applied AI to improve denial rates. Our flagship product, Patient Access Curator™, uses AI to address key drivers, such as eligibility and COB errors that account for 15-30% of all denials. AI can surveil system and user activity to detect missed coverage or primacy issues, then pursue those leads and update the HIS in real-time — both at registration and at every other touchpoint in the patient journey. Another great example of applied AI is our AI Advantage™ denial prediction and triage solution. While claim denial screening and prioritization are not new concepts, AI takes this to a new level by integrating behavioral analytics, machine learning processes and big data analytics into a simplified process. This solution doesn't just detect denials; it prioritizes them based on financial impact and likelihood of denial recovery, driven by a larger decision support framework that improves accuracy and reduces noise. Revenue cycle teams can then focus on high-value, revenue-protecting activities, rather than low-yield procedural work. Our models continuously learn from evolving payer behaviors as they emerge, to predict denial risk and recommend corrections in real time. And because they're continuously learning, they get smarter and vastly more adaptive than legacy ways of prioritizing pre-denial and denial workflows. It's a dynamic system that evolves with the payer landscape that maximizes limited resources, which I think is the hope and expectation of modern, AI-driven revenue cycle processes." Q3: "Can you give us a sense of the impact? What kind of results are clients seeing with AI tools?" David: "Absolutely. We are seeing some amazing early data that clearly point to very differentiated outcomes over traditional technology approaches. Since deploying our AI-driven denial prevention engine, we've seen a 15-60% reduction in initial eligibility and COB claim denials, with an average performance of ~30% reduction across our client base. However, the impact is not just on claim denials; we have to understand there are populations of patients, such as self-pay patients, that benefit from improved automation and intelligence that AI applied correctly can bring. We are also seeing significant reductions in self-pay at registration rates when AI is driving the automation. Here, we see ~25% reductions in self-pay at the time of registration. This is relevant and striking on so many levels, as correct estimates can now be provided pre-service, and authorization processes can now work more effectively, which leads to better patient experiences. What's most impactful is how these results compound over time. As AI tools mature, they start identifying systemic issues—like recurring documentation gaps or payer-specific quirks—that manual reviews often miss. That insight enables clients to fix individual claims while optimizing workflows and upstream processes, leading to long-term gains in efficiency and revenue integrity." Learn how Patient Access Curator streamlines patient access and billing, prevents claim denials, improves data quality, and makes real-time corrections to boost your healthcare organization's bottom line. Q4: "Let's talk about the patient side. A lot of innovation is happening behind the scenes, so how does that translate into a better patient experience?" David: "That's a great point. A lot of what we do in revenue cycle innovation isn't visible to patients, but it absolutely impacts their experience. In many cases, our patients are the victims of broken processes and fragmented data that AI and related technology improvements will help to resolve. Take claim denials, for example. When a claim is denied because of a missing authorization or incorrect insurance information, it doesn't just delay payment; it creates confusion and stress for the patient who may suddenly receive a surprise bill for something outside of their control. Resolving this issue requires multiple calls to the provider or payer, which adds frustration. This creates a stressful experience and negatively impacts the provider's brand perception. That's where AI makes the difference. We use Experian Health's AI-powered registration optimization and claims management tools, like AI Advantage, to catch these issues early, before the incorrect estimate is generated, before the authorization is missed or before the claim is submitted. This drives more consistency and automation into the revenue cycle. By improving data accuracy at the front end—with things like insurance verification, COB issue detection, automated coverage surveillance and predictive analytics — we're helping providers get it right the first time. The result: fewer billing surprises, faster resolutions and a smoother patient journey. While the patient may not see the AI working in the background, they feel the difference when their estimates are more accurate, duplicate or conflicting statements are reduced, and they no longer have to chase down answers. This builds trust and improves patient satisfaction – allowing them to focus on their health, rather than revenue cycle issues they should never have to deal with." Q5: "For healthcare organizations that are just starting to modernize their revenue cycle, where should they begin?" David: "Start by understanding your internal views, change threshold and restrictions. Many healthcare providers don't ask hard questions about their goals, the data they're willing to share or how to prioritize their needs. AI is only as good as the data it has access to, so ensure your data is clean, structured, and compliant with legal and clinical requirements. Next, find partners with the right technical tools and healthcare experience. Focus on measurable outcomes —not just technology—and prioritize areas with the greatest revenue leakage, high FTE investments or elevated patient risk. Don't underestimate the importance of change management. Involve your operations, training and strategy teams early, and make them part of the innovation process. Overemphasize the human element of change control to improve outcomes. Finally, always keep the patient in mind. Every improvement in the revenue cycle affects their experience and access to care. Design technology solutions that simplify the patient journey, reduce their burden, and help lower the cost of care." The future of RCM lies in AI innovation  As healthcare organizations navigate mounting financial pressures and the increasing complexity of payer requirements, the need for smarter, AI-powered solutions has never been greater. By embracing intelligent automation, providers can reduce costly errors and denials, strengthen their financial stability and enhance patient experiences. Learn how Experian Health's AI-driven solutions, like Patient Access Curator and AI Advantage, can help your healthcare organization minimize claim denials, streamline workflows and unlock new opportunities for financial success. Learn more Contact us

“Registrars used to wonder, ‘Do I run Coordination of Benefits? Which insurance is primary?’ Now Patient Access Curator does all that work and removes the guess work, and it does it in under 20 seconds.”Randy Gabel, Senior Director of Revenue Cycle at OhioHealth Challenge OhioHealth faced rising denial rates and inconsistent insurance discovery. Registrars relied heavily on what patients told them at check-in, without knowing if that information was complete or current. Forced to make judgment calls about whether to run Coordination of Benefits (COB) or check for Medicare Beneficiary Identifiers (MBI), staff could do little to avoid errors and denials. Randy Gabel, Senior Director of Revenue Cycle at OhioHealth, says, "We were sending claims with the wrong insurance simply because staff didn't know what to do next." They needed a reliable solution to identify coverage upfront – without asking patients to dig out old insurance cards or involving costly contingency vendors. OhioHealth's search became more urgent when a nationwide cyberattack hit the industry in early 2024. They needed a trusted revenue cycle partner to close the gaps in claims and eligibility workflows and prevent denials from the start. Solution To strengthen front-end revenue cycle operations, OhioHealth selected Experian Health's Patient Access Curator® (PAC). This all-in-one solution uses artificial intelligence (AI) and machine learning to check eligibility, COB, MBI, demographics and insurance discovery through a single process. This solution gave staff more accurate data in real-time. Although they had not worked with Experian Health before, the OhioHealth team was immediately convinced that Patient Access Curator fit the bill. Gabel says that during the evaluation, "Patient Access Curator discovered a whopping 18% more insurance on self-pay accounts than our current vendor. No other company or product found that much." PAC fits directly into existing workflows, so OhioHealth's 800+ staff members did not have to learn a new tool or change their daily processes. And with real-time insurance discovery and auto-population of coverage data into Epic, staff no longer needed to rely on guesswork and manual data entry. The tool's ability to automatically determine primacy and remove expired coverage meant staff could submit claims with confidence. "One of the primary reasons we chose Experian and Patient Access Curator was because it makes the manual work of revenue cycle much easier on the registration teams, which in turn improves productivity, empowerment and morale," said Gabel. Outcome When Patient Access Curator went live, the effects were felt almost immediately. Registrars who once spent valuable time debating which checks to run found that PAC handled those decisions automatically, and much faster. Manual searches were no longer necessary, and the system's accuracy drastically reduced the number of errors. These front-end improvements have boosted performance throughout the revenue cycle. Clean registrations meant fewer denied claims, less manual cleanup and faster reimbursements. PAC even uncovered insurance for accounts that had already been sent to collections, helping OhioHealth reduce reliance on contingency vendors and cut avoidable bad debt. PAC continued to prove its value long after it went live. Within the first year, OhioHealth achieved: 42% reduction in overall registration/eligibility-related denials 36% decrease in COB-related denials 69% drop in termed insurance-related denials 63% fewer incorrect payer-related denials $188 million in claims unlocked by reassigning staff and improving productivity What's next? Building on this success, OhioHealth's next steps are to expand their use of PAC by launching a patient financial experience initiative. This will allow patients to complete registration themselves and find their own coverage without waiting for a staff member to become available to help. Resolving more insurance issues upfront will deliver a faster, easier and more transparent registration experience from the start. With Patient Access Curator, OhioHealth has gone from losing time and money dealing with the downstream effects of claims errors to ensuring coverage accuracy at the source – while cutting denials by almost half. Along with a better experience for staff and patients, these gains have created a more resilient revenue cycle, ready to withstand whatever unexpected changes may be in store. Find out more about how Patient Access Curator prevents claim errors before they begin, helping teams submit clean claims and reduce denials. Learn more Contact us

Key takeaways: Billing mistakes and claims delays are common when providers rely on manual patient insurance verification processes. Automated patient insurance verification can speed up eligibility checks and ensure patient insurance and billing information is accurate. Claims denial rates go down and reimbursement rates go up when providers adopt real-time insurance eligibility technology. Patient insurance verification is critical to managing healthy revenue cycles. Without a complete picture of a patient's insurance policy details—like payable benefits, deductibles and co-pay thresholds for out-of-pocket maximums—providers run the risk of non-reimbursement. Yet, many providers still rely on manual insurance verification processes that are often error-prone, resulting in high claims denial rates. Implementing patient insurance verification software helps boost both accuracy and speed, ultimately helping health organizations reduce claims denial and keep revenue cycles on track.  What is insurance verification? In healthcare, insurance verification is the process of confirming if a patient has active medical insurance coverage and finding missing health insurance. Also called an eligibility check, insurance verification typically takes place before a patient receives care, even if they are a long-time patient. During insurance verification, providers check insurance status, coverage details, benefits for medical services and billing details. To keep revenue cycles on track, providers must have the most up-to-date patient insurance information on file to maintain more accurate billing and reduce costly and time-consuming claim denials. Insurance verification also benefits patients by helping them better understand their financial responsibility so they can plan for out-of-pocket costs. Challenges of manual insurance verification processes Many healthcare organizations still rely on manual insurance verification processes to check patient insurance information. Unfortunately, running eligibility checks by hand can result in increased mistakes, a heavy administrative burden on busy staff and higher claim denial rates. Here's a closer look at some of the common challenges of manual insurance verification. Prone to errors Patients typically provide their insurance information when they register or check in for an appointment with a provider. However, this information can be outdated, incorrect or incomplete. According to Experian Health data, nearly half of providers (48%) say data collected at registration or check-in is somewhat or not accurate, and 20% of patients report encountering errors in their medical records and/or billing information. Patients may make mistakes when entering information, switch insurance coverage after filling out their paperwork or forget about secondary coverage they may have. Staff can also incorrectly input patient information from a paper form into a billing system or forget to update a patient’s file with new insurance information. Workflow bottlenecks and reduced efficiencies Staff often get bogged down correcting errors or may waste valuable time contacting patients by phone to update insurance information. Billing errors that result from mistakes made during patient insurance verification also create extra work for staff. Inaccurate insurance information may also result in patient confusion about out-of-pocket costs and disrupt care, further jamming up collections and patient scheduling for busy practices. The 2025 State of Patient Access Survey shows that one in five patients face challenges before they even get to see a provider due to data and information discrepancies, while 22% of patients reported experiencing delays in care due to insurance verification. Increased claim denials When providers submit claims with inaccurate or outdated information, it can result in delayed claims processing or denials. More than half (56%) of providers say patient information errors are a primary cause of denied claims. Claims may require rework and resubmission due to outdated billing information, which adds even more delays and burdens staff. Providers may also bill the wrong payer if a patient has unknown secondary insurance coverage and needs to resubmit to the correct provider. Bottlenecks in claims management that result from manual insurance verification create headaches for staff and patients. They also directly impact cash flow, potentially disrupting a provider’s entire revenue cycle. How insurance verification software can improve efficiency When providers leverage insurance verification software, like Experian Health’s Insurance Eligibility Verification solution, there are fewer medical billing errors, cleaner claims submissions and staff are no longer burdened by time-consuming, tedious manual tasks. Automation of eligibility checks: Automating insurance verification throughout the entire patient financial journey ensures cleaner claim submissions, speeds up reimbursement and reduces medical billing errors. Other tools like Experian’s Health’s Coverage Discovery automatically work across the entire revenue cycle, searching both commercial and government payers to find previously unknown coverage, identifying accounts as primary, secondary or tertiary coverage. Real-time coverage and benefits updates: Insurance verification software ensures patient information is always up-to-date. Experian Health’s solution, for example, lets providers access real-time patient reliability data by connecting with over 900 payers. Additionally, its optional Medicare beneficiary identifier (MBI) lookup service can automatically find and validate Medicare coverage—a process that’s commonly done manually. Integration with existing systems and interfaces: Automated insurance eligibility solutions that integrate seamlessly with the tools providers are already using—like claims management and health record systems—accelerate insurance verification, keep patient insurance information up-to-date and allow staff to leverage data analytics to further streamline operations. For instance, Experian Health clients have access to insurance verification tools through eCare NEXT®, which offers a single interface for staff to manage several patient functions. Key features to look for in insurance verification software Healthcare organizations adopting patient insurance verification software should prioritize solutions offering features such as multi-payer support, real-time eligibility checks and analytics tools. As healthcare regulations continue to evolve, especially around price transparency, providers adopting insurance verification software will also benefit from partnering with a solution provider that offers compliance support. Embracing patient insurance verification technology helps providers get paid faster The entire revenue cycle hinges on timely and accurate payer reimbursements. Although often underestimated, the right patient insurance verification solution can be the key to minimizing reimbursement roadblocks and getting claims paid faster. Automating patient insurance checks as early as registration—and at every step along the patient journey—helps providers prevent cash flow issues and reduce long-term revenue losses. Learn more about how Experian Health’s Insurance Eligibility Verification solution can help healthcare organizations reduce eligibility verification errors and accelerate reimbursements. Learn more Contact us

For patient access leaders at large healthcare organizations, the pressure is mounting and has been building for some time. Healthcare claim denials are climbing. Staffing is stretched, and the tools healthcare organizations have relied on for years are no longer enough. But what if providers could stop denials before they start? Welcome to the new era of denial prevention in healthcare, powered by predictive intelligence. Experian Health's innovative artificial intelligence (AI) solutions, Patient Access Curator and AI Advantage™, were designed to help organizations prevent denials before they occur. Explore how Experian Health is reshaping the way health systems manage Coordination of Benefits. Learn how automation and AI are eliminating manual errors, reducing denials and unlocking millions in recoverable revenue. Watch now > The denial spiral explained: A systemic challenge in revenue cycle management  Claim denials aren't just a back-end billing issue. They're a symptom of upstream breakdowns—often rooted in inaccurate or incomplete patient data at registration. According to Experian Health's 2024 State of Claims Survey, 46% of denials are caused by missing or incorrect information. And the cost of reworking a denied claim? $25 for providers and $181 for hospitals. The result? A denial spiral that drains resources, delays reimbursements, and frustrates patients and staff alike.  Why Epic users are especially vulnerable While Epic is a powerful EHR platform, many Epic-based organizations still rely on staff to make complex decisions at registration. Questions like: Is this coverage primary? Should discovery be run? Is this data accurate? ...are often left to frontline staff. This guesswork leads to inconsistent outcomes—and denials. What's needed is a layer of predictive intelligence that works within Epic to automate and correct data before it becomes a problem.  How Patient Access Curator fixes registration errors Patient Access Curator is that layer. Patient Access Curator is an all-in-one solution that automatically finds and corrects patient data across eligibility, Coordination of Benefits (COB) primacy, Medicare Beneficiary Identifiers (MBI), demographics and insurance discovery—within seconds. It integrates directly into Epic workflows, eliminating the need for staff to toggle between systems or make judgment calls on the fly. Instead of relying on registrars to catch every error, Patient Access Curator uses machine learning and predictive analytics to: - Identify and correct bad data in real time - Return comprehensive coverage directly into Epic - Reduce denials, write-offs, and vendor fees - Improve staff morale by removing administrative burden As one early-adopting Patient Access Curator client puts it: "If your current workflow still depends on frontline decisions, you're not just risking denials—you're building them in."  Predictive intelligence in healthcare: AI Advantage at work While Patient Access Curator fixes the front end, AI Advantage tackles the middle of the revenue cycle, where claims are scrubbed, edited, and submitted. At Schneck Medical Center, AI Advantage helped reduce denials by 4.6% per month and cut denial resolution time by 4x. The tool flags high-risk claims before submission and routes them to the right biller for correction. It also triages denials based on the likelihood of reimbursement, so staff can focus on the claims that matter most. Together, Patient Access Curator and AI Advantage form a closed-loop system: - Patient Access Curator ensures clean data at registration - AI Advantage predicts and prevents denials mid-cycle - Both tools integrate seamlessly with Epic and ClaimSource®  Why predictive denial prevention matters for patient access leaders  By implementing denial management technology and predictive intelligence, healthcare teams aren't just managing workflows; they're managing risk. Every inaccurate field, every missed coverage, every manual decision is a potential denial. Patient Access Curator and AI Advantage remove that risk by replacing guesswork with certainty. And the benefits go beyond revenue: - Fewer denials mean fewer patient callbacks and less frustration - Cleaner data means faster reimbursements and fewer write-offs - Automation means staff can focus on patients, not paperwork As Jason Considine, President at Experian Health, recently shared: "Our mission is to simplify healthcare. That starts by getting it right the first time, before a claim is ever submitted. With the power of AI and predictive intelligence, we're no longer waiting for denials to happen; we're helping providers proactively prevent them. Tools like Patient Access Curator and AI Advantage allow healthcare organizations to identify issues at the point of registration and throughout the revenue cycle, so teams can focus on care, not corrections. It's about working smarter, reducing risk and protecting revenue."  Denial prevention checklist: Preparing patient access teams for predictive denial prevention  Denial prevention is here, but what if billing teams aren't quite ready? To move toward a predictive denial prevention strategy, healthcare organizations can invest in the following five areas:   Audit front-end workflowsMap out every step from patient registration to claim submission. Identify where manual decisions are being made—especially around eligibility, COB, and insurance discovery. Ask: "Where are we relying on staff judgment instead of system intelligence?" Train staff on data quality awarenessReinforce the impact of inaccurate or incomplete data on downstream denials. Use real examples to show how a single missed field can lead to rework, write-offs, or patient frustration. Introduce the concept of "first-touch accuracy" as a team-wide goal. Evaluate Epic integration readinessAssess whether current Epic environments are configured to support automation tools like Patient Access Curator. Work with IT to assess whether the current setup allows for real-time data correction and coverage updates. Confirm that teams understand how new tools will integrate into their existing workflows, not replace them. Establish a denial prevention task forceBring together leaders from patient access, billing, IT and revenue cycle to align on goals. Assign ownership for key metrics like clean claim rate, denial rate, and registration accuracy. Use this group to pilot new tools like Patient Access Curator and AI Advantage and gather feedback from frontline users. Communicate the "Why" behind the changeFrame automation as a way to reduce burnout, not replace jobs. Highlight how tools like Patient Access Curator eliminate guesswork and free up staff to focus on patient care. Share success stories from peers (like Schneck Medical Center) to build confidence and momentum. The bottom line: Strategic denial prevention is the future Denial management is reactive. Denial prevention is strategic. For healthcare organizations using Epic, Patient Access Curator and AI Advantage offer a smarter, faster and more scalable way to increase reimbursements and improve the patient experience. Learn more about how Experian Health can help protect revenue, reduce staff burdens and reduce claim denials—starting at the first touchpoint. Learn more Contact us

Key takeaways: Survey data shows that healthcare providers find it harder to secure reimbursement for their services. Automation, staff training and analytics are the keys to preventing denials, improving accuracy and streamlining every step of the claims process. Experian Health's integrated claims management solutions are designed to close the claims gap and accelerate reimbursement. Claims management has become one of the most pressing challenges in healthcare billing. In Experian Health's 2024 State of Claims survey, 77% of providers said they were moderately to extremely concerned that payers won't reimburse them, largely due to changing payer policies and prior authorization requirements. Billing teams are left to work through dense code lists and figure out each payer's distinct playbook, often without the tools or time to catch mistakes. Managing claims efficiently is essential to ensure accurate and timely reimbursement. What is claims management in healthcare? Claims management is the process of preparing, submitting and following up on healthcare claims to ensure providers are paid for the care they deliver. It spans the entire revenue cycle, from verifying coverage during patient intake through final settlement. For revenue cycle teams, good claims management is what keeps finances on track. But with the volume of patients, claims and complex payer rules continuing to increase, the pressure is on organizations to tighten up their processes. Three key findings from the State of Claims survey show what they are up against, when compared with metrics from 2022: 73% of providers say claim denials are increasing 67% report longer reimbursement timelines 55% have seen a rise in claim errors Each denied or delayed claim adds to the administrative burden. However, when claims are submitted correctly the first time, staff can focus on patients instead of paperwork. The claims management process step by step Clean claims start with getting the basics right. "Once you let bad data in the door, it's like a virus," says Jordan Levitt, Senior Vice President at Experian Health. "Every action you take once bad data enters your system is wasting resources." Each of the following steps is a chance to keep the claim moving: Patient intake and verification Staff collect and verify patient demographic information, insurance details and eligibility at patient intake. If any of the information is missing or incorrect, the risk of denial increases immediately. Experian Health's flagship Patient Access Curator addresses this problem directly, using artificial intelligence (AI) and robotic process automation to automatically check and verify these details.   Case study: Experian Health and Exact Sciences See how Exact Sciences used Patient Access Curator to reduce denials by 50% and add $100 million to their bottom line in six months. Medical coding Coding is where clinical services become billable. Staff must select the correct codes from thousands of options covering diagnosis, procedure and supply. If the codes don't match the care provided or a modifier is left out, the claim will come back, leaving money on the table. Claim submission At this stage, all the key data is packaged together and sent to the payer, often through a clearinghouse. Claims should be reviewed line by line for errors before filing, but relying on manual processes is slow and highly risky. Automation offers a better chance at catching issues before the claim reaches the payer. Adjudication and payment posting Once the payer reviews the claim, they'll validate the services, apply negotiated rates and determine payment or denial. Payment posting closes the loop, allowing providers to reconcile accounts quickly and flag underpayments or errors needing further action. Denial management and appeals Not every claim gets paid the first time. When denials come in, teams need to know what went wrong to fix the issue and get the claim resubmitted quickly. Denial management software identifies the reasons for denials and organizes work queues for faster resolution. Patient billing and collections Anything insurance doesn't cover is billed to the patient. If the bill is confusing or shows up late, it's less likely to be paid. Upfront conversations, flexible payment options and convenient point-of-service collections can improve collection rates and patient satisfaction. Best practices for effective claims management Getting ahead of the claims challenge isn't just about fixing denials after the fact, but about preventing them in the first place. Automation, staff training and visibility into what's working (or not) all play a role. Implementing automation and technology Manual work and disconnected systems are a drag on reimbursement. Automation helps standardize routine tasks, reduce errors tied to human input and create consistent workflows that can handle sudden surges in patient volumes. AI takes this to the next level, by predicting denials, flagging coding errors or coverage issues before submission and prioritizing claims that need attention. For example: ClaimSource® is an automated claims management system that organizes claims activity from a single hub. This system makes claims editing and submissions more efficient, by performing customizable edits and checking for errors before submission. On the back end, AI Advantage™ uses AI and machine learning to predict claim outcomes and push urgent tasks to the front of the queue, so staff can spend time on the claims that matter most financially.   Case Study: Experian Health and Schneck Medical Center See how Schneck Medical Center used AI Advantage to achieve a 4.6% average monthly decrease in denials. Training and education for staff Successful claims management depends on a confident team. Staff should undergo regular training to stay current on payer rules, policy changes, coding updates and get support to understand new technology. To that end, Experian Health offers live training and on-demand webinars for teams to hear about the latest industry best practices and to see how others are using different tools. Hands-on consultancy support is also available to help teams get up and running with claims management products. Monitoring and analyzing claims data To improve claims performance, staff also need to be able to see where claims might be getting stuck. Tracking key performance indicators like clean claim rate, denial rate and days in accounts receivable helps staff spot issues. Integrated revenue cycle management tools bring everything together in one place so management can see the full picture and make sense of their data.   Blog: How to choose the right key performance indicators for your revenue cycle Find opportunities to prevent revenue leakage by building a healthcare revenue cycle KPI dashboard populated with the right medical billing metrics. Common challenges in claims management and how to overcome them Even with best practices in place, there will always be challenges and uncertainty. Claims pass through multiple departments, which means multiple opportunities for miscommunications or mistakes. Aligning workflows and claims management systems can reduce friction and help keep data secure. Another hurdle is managing the growing number of tools in use. The 2024 State of Claims report shows that one in five providers uses at least three revenue cycle solutions to pull together each claim, creating more complexity than clarity. Again, choosing claims management software from a single supplier will ensure a neat and efficient process. Finally, there's the challenge of meeting changing patient expectations. For 65% of patients, managing healthcare is overwhelming, especially when it comes to understanding costs and coverage. Organizations must maintain fast, accurate and transparent claims processing for better patient experiences. Next steps for strengthening your claims management approach The impact of claims management goes beyond the balance sheet, directly affecting patient satisfaction and operational efficiency. To move forward, healthcare leaders should ask: Are denial trends being tracked and addressed? Do teams have the tools and training they need? Is automation being used where it can make the most significant difference? Answering "yes" to these questions is the first step toward efficient claims management. With the right support, organizations can shift from daily firefighting to more predictable reimbursement strategies. Find out more about how Experian Health's award-winning claims management solutions help healthcare providers improve reimbursement rates and reduce denials. Learn more Contact Us