All posts by natalie lima

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

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