All posts by natalie lima
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
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.
Experian Health’s 2025 High-Performance Summit was a catalyst for collaboration, innovation and a shared commitment to simplifying healthcare – for both providers and the patients that they serve.
To meet evolving price transparency regulations, University of Tennessee Medical Center (UTMC) partnered with Experian Health to implement Patient Estimates. This integrated solution helped UTMC maintain compliance, increase estimate delivery and empower patients with clearer cost breakdowns.
AI is reshaping patient access by reducing manual errors and preventing costly claim denials. Tools driven by AI and automation can streamline eligibility checks and coordination of benefits — helping providers improve efficiency, cut costs, and deliver a better patient experience.
Propensity-to-pay models forecast which patients are likely to pay their bills, enabling smarter prioritization. By using data-driven automation, these tools help healthcare providers boost collections, reduce bad debt and improve overall revenue cycle efficiency.
Claim denials are increasing, putting pressure on staff and revenue. Experian Health's latest report outlines key factors driving denials today and how AI and automation can help providers strengthen claim accuracy and financial performance.
“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