All posts by natalie lima

“Experian Health helped us meet the compliance of the Price Transparency Rule. Without it, we would have been subject to large fines.”— Marianna Ross, Manager of Customer Services and Financial Counseling at UTMC Challenge Before 2020, UTMC, a leading Level 1 Trauma Center that serves patients across three states, relied on a manual, time-consuming patient estimate process. But when the Centers for Medicare & Medicaid Services (CMS) issued its Hospital Price Transparency Rule, UTMC’s patient access leaders knew their existing processes couldn’t keep up with new price transparency regulations. UTMC’s financial counselors were still manually extracting charges and CPT codes using historical claims in an internal reporting system. Without a digital system in place, the team was struggling to do its job efficiently, and patients weren’t always able to get information required by the ruling. To avoid compliance penalties, UTMC needed a streamlined estimate process with better tools and the necessary integration to provide clear, upfront price estimates. The new process also needed to be reliable under a potential CMS audit and simple for staff to use while allowing for future scalability. Solution To ensure the hospital could keep up with changing price transparency regulations, UTMC partnered with Experian Health and implemented Patient Estimates. Instead of tedious manual patient estimate processes, Patient Estimates pulls information from the hospital’s chargemaster, payer contracts (integrating with Experian Health’s Contract Manager), claims history and real-time eligibility data. Patient Estimates gave staff confidence to generate accurate patient estimates, while patients felt empowered to read a clear, detailed estimate specific to their procedure. Plus, its built-in reporting meant UTMC could easily demonstrate its compliance with the new Hospital Price Transparency Rule. And after a successful implementation and fulfilling all 2021 Hospital Price Transparency Rule mandates, UTMC continued working with Experian Health to develop a robust and unified patient payment strategy. In addition to Patient Estimates, the following Experian Health solutions were implemented: Self-Service Patient Estimates to enable patients to generate either a self-pay estimate or price estimates for services using their current insurance information. PaymentSafe® to support pre-service and secure point-of-service transactions. Patient Financial Advisor to deliver text estimates to patients’ mobile phones with the option to pay. The timing of the new processes couldn’t have been better. In 2024, UTMC’s Board set a strategic goal to increase the number of estimates delivered within the year. With Patient Estimates, Self-Service Patient Estimates, PaymentSafe and Patient Financial Advisor working together, the team didn’t just meet the goal — they exceeded it by 42.77%. Outcome With a fully integrated system now in place, staff and patients both get access to accurate estimated cost breakdowns—and estimates are sent a few days earlier than UTMC’s previous process. With robust cost breakdowns and multiple payment options, staff are empowered to engage in more compassionate financial conversations and patients have more time to consider the cost of care and make financial arrangements. According to Ross, “Estimates and payments are complicated to unravel for many of our patients. And patients are scared and nervous about procedures. It is helpful to have a simple, clear breakdown of costs to help guide these conversations.” With Experian Health’s Patient Estimates, Self-Service Patient Estimates, PaymentSafe and Patient Financial Advisor working together, UTMC delivered big results in compliance and the number of estimates it issues. Ross encourages other hospitals going through similar transitions to first invest in their contract data—and that includes finding the right technology partners. She notes that partnering with Experian Health was critical to the success of UTMC’s new patient payment system. “Experian Health evolved with us as our needs progressed and changed to ensure we received the most from the products.” Ross also reminds organizations who are making the switch to educate patients: “This is a cultural change, not just a system change. And like all change, it takes time.” Learn how price transparency solutions from Experian Health can help healthcare organizations stay compliant with current regulations and help patients better understand their costs. 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

Key takeaways: Healthcare organizations are facing growing levels of bad debt and a sharp decline in collections. Propensity-to-pay models that utilize machine learning and robust data offer insight into a patient's likelihood to pay and allow staff to focus their collections efforts where they matter most. In 2024, Experian Health clients that implemented Collections Optimization Manager saw a 10:1 ROI. Some clients, like Weill Cornell Medicine, have seen up to $15 million in recoveries. Healthcare organizations are facing a sharp decline in collections and an increase in bad ​​debt. Rising self-pay costs and more patients struggling to afford their medical bills are contributing factors. Inefficient collections practices, reliance on third-party agencies that don't utilize propensity to-pay scores and manual processes are also key contributors to this growing market problem. Providers who adopt propensity-to-pay models that use data and automation to forecast the likelihood of payment often see both improved revenue recovery and patient satisfaction. Here's what to know about propensity-to-pay collections strategies in healthcare. Why propensity to pay matters in healthcare collections "Propensity to pay" is a data-driven model that identifies patient populations with the greatest likelihood of paying, to enhance existing collection strategies. When billing teams better understand a patient's propensity to pay, they can easily prioritize outreach and allocate collections resources effectively. This eases their workload, as they can focus their efforts where they'll have the greatest impact, and on accounts with the highest probability of payment. Keeping more collections in-house also reduces the reliance on expensive third-party agencies, while eliminating wasted effort on low-yield tasks – like repeated phone calls or mailed statements to accounts unlikely to pay. The need to adopt propensity-to-pay models has grown in recent years as patient volumes and the cost of care continue to grow. In the last 20 years, U.S. hospitals have absorbed nearly $745 billion in uncompensated care, according to American Hospital Association data.American Hospital Association Rising healthcare costs and the newly enacted "One Big Beautiful Bill Act" are expected to shift even more financial responsibility to both hospitals and ​​patients. Unfortunately, many organizations still rely on inefficient collections processes, third-party agencies and medical billing practices that lack propensity-to-pay insights. The result? Disruptions to the entire revenue cycle, including lost patient revenue, wasted resource hours, increased costs to collect, and high vendor costs. Using outdated collections strategies also contributes to patient dissatisfaction and churn, causing even more revenue leaks. Why healthcare providers need propensity-to-pay analytics Limited staff capacity and high volumes of self-pay accounts further compound collections challenges for organizations that have yet to adopt propensity-to-pay analytics. As collections timelines drag out, providers can be left with cash flow issues, revenue losses and bad debt. This ultimately disrupts the revenue cycle and affects the quality of patient care – and the entire patient experience. By leveraging propensity-to-pay analytics, revenue cycle leaders can boost revenue cycle predictability and streamline collections efforts. Listen in as Weill Cornell Medicine and Experian Health discuss how a smarter collections strategy delivered $15M in recoveries – and how you can do the same. This on-demand webinar shows how to move faster, work smarter and collect more, without adding headcount. Watch now > How propensity-to-pay models work in practice Propensity-to-pay models screen and segment patient accounts based on the likelihood of payment. Segmented accounts receive a propensity-to-pay score – from 1 to 5, with 1 being the highest likelihood to pay — and are then transferred to appropriate reconciliation channels. Experian Health's solution, Collections Optimization Manager, leverages machine learning, predictive analytics and data sources – like credit, behaviour and demographics – to identify which patient accounts have the highest likelihood to pay. It also automatically screens patient data for deceased, bankruptcy, Medicaid and ​​charity. Patient accounts are then sorted into pay groups through data-driven segmentation. This allows busy collections staff to quickly clean up accounts receivable and put their focus where it matters most – patient accounts with the strongest chance of paying their bill. With a clear picture of a patient's financial situation, healthcare organizations can improve patient communication and further boost collections efforts to maximize revenue. High-propensity accounts may receive light-touch reminders, like less frequent bill reminders. At the same time, alternative financial assistance, such as charity care or payment plans, can be made available automatically to low-propensity patients. Benefits of using propensity-to-pay models Propensity-to-pay models, like Experian Health's Collections Optimization Manager solution, offer numerous benefits to organizations that strengthen the revenue cycle. Higher collections rates: Using a propensity-to-pay model makes AR more manageable, especially for high-patient-volume organizations. Complimentary tools, like Experian Health's PatientDial and PatientText, easily send self-pay options via voice or text message, boosting patient engagement and building trust. Reduced bad debt: Propensity-to-pay models help identify patients with a low likelihood of paying their medical bills. Lower collections costs: Chasing payments on accounts that are deceased, bankrupt, or eligible for Medicaid or charity wastes valuable resources. With propensity-to-pay models, busy staff can efficiently work on high-yield accounts in-house, reducing the number of accounts that need to go to third-party vendors. Faster cash flow: Prioritize likely-to-pay patients early and shorten payment cycles, which can improve revenue cycle predictability.  On-demand webinar: Boost self-pay collections – Novant Health & Cone Health’s 7:1 ROI & $14M patient collections success Hear how Novant Health and Cone Health achieved 7:1 ROI and $14 million in patient collections with Collections Optimization Manager.  Case study: How Wooster Community Hospital collected $3.8M in patient balances with Collections Optimization Manager Read more about how automated collections strategies helped Wooster Community Hospital achieve a $3.8 million increase in patient payments. Implementing propensity-to-pay analytics: Best practices Healthcare organizations that implement propensity-to-pay analytics should consider the following best practices:  Choose the right partner. Look for a technology partner, like Experian Health, with extensive data assets and healthcare expertise. Automate patient communication. Reduce overhead and increase collections efforts with automated patient communication strategies. Ensure alignment with legacy technology. For real-time accuracy, choose a solution that integrates seamlessly with existing EHR and billing systems. Train billing staff. Provide comprehensive training to billing and collections teams on propensity-to-pay scores and how to communicate payment options with empathy. Automate the agency management. Reduce the manual workload of auditing agency remittances by automating the reconciliation process. Monitoring patient accounts. Look for a solution that regularly scans for changes or updates in a patient's ability to pay or contact information. Track performance. Monitor key performance indicators to fine-tune the collections process over time and improve forecasting. How Experian Health's solutions support better collections Changing longstanding collections practices is often a significant investment. Yet, the cost of inaction is often greater. Experian Health's Collections Optimization Manager uses propensity-to-pay models, driven by machine learning, and data-driven workflows to help healthcare providers improve patient collections. Our comprehensive industry-leading solution offers a smarter and faster way to collect patient payments, and Experian Health's experienced consultants are there every step of the way, as collections needs shift. Learn more about how Experian Health's data-driven patient collections optimization solution helps revenue cycle management staff collect more patient balances. Learn more Contact us

Key takeaways: Experian Health’s State of Claims 2025 report is out now, detailing providers’ views on claims management and how these have changed since the survey began in 2022. Claim denials are still on the rise, causing providers to find faster and more efficient ways to submit clean claims the first time. When it comes to solutions, optimism about artificial intelligence (AI) is high, but uptake remains surprisingly low. AI-powered tools like Patient Access Curator™ and AI Advantage™ can help healthcare providers reduce claim denials while optimizing the claims management process. According to Experian Health’s State of Claims 2025 report, claim denials continue to negatively impact America’s healthcare providers. This quantitative survey of 250 healthcare professionals, carried out in June and July 2025, reveals providers’ concerns about rising denial rates, staffing shortages and uncertainty over whether payers or patients will ultimately pay. The findings show that providers are open to new claims processing and denial reduction solutions. However, while providers are enthusiastic about artificial intelligence's ability to ease the squeeze, only a small fraction are actually using it. This article highlights a few key takeaways from healthcare providers' statements about the current challenges in claims management and the factors that contribute to their responses. NEW: State of Claims 2025 Report Download the State of Claims 2025 report to see the full findings. Takeaway 1: Claim denials are on the rise again This year’s survey confirms what providers have been seeing for several years: claim denials are not letting up. In 2022, 30% reported that at least 10% of their claims were denied. By 2024, the figure had grown to 38%. Now, in 2025, 41% of providers say their claims are denied over 10% of the time. If this trend continues, how much further could denial rates climb? Claim denials are becoming a growing part of everyday operations, demanding more time, staff and resources. Margins that are already under pressure are strained further by missed reimbursements. And when insurers don’t pay, more of the bill falls to patients, many of whom are already struggling to manage medical costs. Half of respondents said they are “very or extremely concerned” about patients’ ability to pay, up six percentage points from last year. For many organizations, the question is not whether denials will continue, but how best to prevent them before the financial burden worsens. Blog: Denial prevention - Why manage denials when you can prevent them? Read more about how our claims management solutions help providers build effective denial prevention strategies and reduce lost revenue. Takeaway 2: How bad data leads to more healthcare claim denials The report lists several of the top triggers for denials, but inaccurate and incomplete data continue to stand out. More than half of providers (54%) say claim errors are increasing, and nearly seven in ten (68%) report that submitting clean claims is more challenging than it was a year ago. Many of these errors originate at registration. Incomplete or inaccurate information collected during check-in is now the third most common cause of denials, with 26% of respondents saying that at least one in ten denials at their organization can be traced back to intake errors. Every mistake sends ripples downstream, leading to costly rework, avoidable payment delays and unnecessary patient stress. Tightening up patient access processes and accurate data collection is one of the best things providers can do to curb denials. With that in mind, Experian Health’s Patient Access Curator is designed to help providers capture accurate data the first time. Using AI and machine learning, it consolidates eligibility checks, coordination of benefits, Medicare Beneficiary Identifier (MBI) verification, demographics, insurance coverage and financial status into a single workflow. This allows providers to: Quickly collect accurate patient information upfront Eliminate the need to re-run eligibility checks, which now take more than 10 minutes for over half of providers Reduce manual data entry errors that lead to downstream denials Free up staff time for higher-value tasks Case study: Experian Health & OhioHealth See how OhioHealth cut denials by 42% with Patient Access Curator and solved claim errors at the source. Takeaway 3: An AI paradox in healthcare claims: High optimism, low adoption Patient Access Curator is a great example of how AI can help address the data problems behind denials. But clean data alone isn’t enough. Errors and risks still emerge mid-cycle. Here, AI Advantage offers another application for AI, using predictive analytics to identify high-risk claims before submission and routing them for correction. It also triages denials based on the likelihood of reimbursement, so staff don’t lose time on unproductive rework. 69% of healthcare providers who use AI say that AI solutions have reduced denials and/or increased the success of resubmissions.State of Claims 2025 report | Experian Health The survey shows many providers are enthusiastic about AI's potential: 67% believe AI can improve the claims process, and 62% are very confident in their understanding of how AI differs from automation and machine learning, up sharply from just 28% in 2024. Despite this optimism, adoption is surprisingly low. Only 14% of providers are currently using AI to reduce denials. The survey suggests that even though the majority of AI adopters report fewer denials and more successful resubmissions, fear of the unknown seems to be slowing progress. Blog: Leveraging artificial intelligence for claims management Read more about how our AI-powered claims management solutions help healthcare providers improve reimbursement rates and reduce denials. Takeaway 4: Tech upgrades aren’t enough without integration Even if they remain on the fence about AI, providers are still moving to modernize claims management. Only 56% believe their current technology is sufficient to handle revenue cycle demands, a major drop from 77% in 2022. This explains why 55% are willing to completely replace their existing claims management platform if presented with a compelling return on investment. Much of the frustration comes from fragmentation. Nearly eight in ten providers say their organizations still rely on multiple solutions to collect the information needed for a claim submission. Switching between systems slows down intake, creates duplication and increases the risk of errors that feed directly into denials. An integrated solution like Patient Access Curator solves this problem by replacing a patchwork of tools with a single platform that manages intake and eligibility in one workflow. Information is captured in one place, reducing the duplication and errors that are inevitable when data is entered into multiple databases. Extending this with AI Advantage links front-end accuracy with back-office intelligence, giving providers a connected denial-prevention system rather than stitching together isolated fixes. With fewer tools to log into, staff can work more efficiently and focus on submitting cleaner claims. 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 > Closing the technology gaps in claims management to prevent denials The 2025 State of Claims report clearly shows that denials remain a persistent and costly problem for healthcare organizations. An overwhelming majority say that reducing them is a top organizational priority. Beyond the financial concerns, the survey reveals a system still held back by data errors, fragmented technology and delays. At the same time, there are hints of cautious optimism. Last year, many providers felt in the dark about AI and machine learning. This year’s survey shows that awareness of these technologies has grown considerably, even if adoption is still early. As the report sheds light on how leaders are weighing investments in new technology, the question now is whether providers can turn growing confidence in AI into action that delivers the results they need. To see the full picture of where claims management stands today, and where it could go next, download the State of Claims 2025 report. Download now 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

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