Claims & Contract Management

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State of Claims 2025 survey, 73% of providers agree that claim denials are increasing, which is a clear signal that outdated processes cost providers millions.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

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

Key takeaways: Manual work and disconnected claims management systems are often error-prone, resulting in delayed and denied claims. Technology, like automation and AI, can help healthcare organizations predict and prevent potential claims issues before submission. Implementing AI-powered claims management solutions should be a top priority for revenue cycle leaders. Healthcare claims denials are on the rise — but so is a new era of technology that can predict and prevent denials before they occur. Leveraging artificial intelligence (AI) for claims management can help organizations break the denial cycle and keep revenue cycles churning. In this article, we’ll explore how solutions like Experian Health’s innovative Patient Access Curator and AI Advantage™ are designed to help providers reduce claim denials with ​AI. 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 > Updating healthcare claims management tools  Claims management is 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. Revenue cycle leaders know that good claims management is the key to healthy cash flow and a strong financial foundation. However, with patient volumes growing and complex payer rules increasing, traditional claims management solutions can no longer keep up. As a result, today’s healthcare organizations are feeling the squeeze to update their claims management processes and adopt solutions that rely on automation and AI-powered analytics to better predict, prevent and process denials. Predicting and preventing denials with artificial intelligence​ Healthcare providers can stop the denial spiral before it begins by capturing accurate and complete patient data at registration. According to Experian Health data, 46% of denials are caused by missing or incorrect information. Now, many healthcare organizations are accelerating their digital transformations by implementing automation and AI tools designed to predict and prevent denials. Automation creates consistent workflows, standardizes routine tasks and reduces human errors. At the same time, AI takes claims management to the next level by predicting denials, flagging claims errors before submission and prioritizing claims that need attention. Leveraging AI solutions that form a closed-loop system can ensure clean data at registration while predicting and preventing denials. Front-end solutions Tools like Patient Access Curator automatically find and correct patient data within seconds — across eligibility, Coordination of Benefits (COB) primacy, Medicare Beneficiary Identifiers (MBI), demographics and insurance discovery. Machine learning and predictive analytics allow providers to identify and correct bad data in real time, without the need for guesswork. Ken Kubisty, VP of Revenue Cycle at Exact Sciences, shares how Patient Access Curator improved eligibility processes, reduced errors and more. Back-end solutions Experian Health’s AI Advantage uses AI and machine learning to predict and prevent denials. AI Advantage not only predicts claim outcomes mid-cycle, but pushes urgent tasks to the front of the queue — allowing staff to prioritize the claims that matter most financially. Extending the automation advantage To minimize denials and delays, providers can look to implement automation and artificial intelligence across the entire claims ecosystem. For instance, Patient Access Curator and AI Advantage integrate seamlessly with solutions that manage the entire claims cycle, like Experian Health’s ClaimSource® — using real-time insights generated by ClaimSource to detect patterns and predict future payer behavior. Additionally, tools like Claim Scrubber can automate the claim scrubbing process — reducing potential errors, administrative burden and the need for costly reworks. Organizations can also add a denials workflow manager to automate and optimize the denial management portion of the claims cycle, improve staff productivity and speed up reimbursement. Artificial intelligence for claims management ​FAQs Want to learn more about how Experian Health’s AI tools can help reduce and prevent claim denials? Consider these commonly asked questions. What is AI Advantage, and how does it help with healthcare claims management? AI Advantage works in two stages of claims management, with two offerings: Predictive Denials and Denial Triage. In stage one, Predictive Denials uses AI and machine learning to look for patterns in payer adjudications and identify undocumented rules that could result in new denials. This solution also flags claims with a high potential of denial, so the right specialist can intervene before claims go to payers. After a claim has been denied, AI Advantage’s stage two component uses advanced algorithms to identify and segment denials based on their potential value. What is Patient Access Curator, and how does it help reduce claim denials? Experian Health’s Patient Access Curator is a robust patient intake and verification solution designed to eliminate errors that often result in denials, such as missing or incorrect information. Through AI and robotic process automation, Patient Access Curator automatically checks and verifies patient demographic information, insurance details, eligibility and more — reducing claim denial rates and administrative burden. How can AI Advantage and Patient Access Curator work together? Patient Access Curator and AI Advantage form a closed-loop system that offers healthcare organizations a smarter, faster and more scalable way to reduce denials and increase reimbursements while reducing administrative burden on staff. What are real-world results from using these ​solutions? 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. 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. The bottom line: Providers can reduce claim denials with AI Leveraging artificial intelligence for claims management can improve the overall efficiency and accuracy of healthcare claims processing — leading to fewer denials and a more seamless patient experience. Instead of waiting for denials to occur before taking remedial action, healthcare organizations can stay a step ahead with claims management solutions that utilize AI and automation. These tools can help proactively detect errors and diagnose claims process weaknesses for a healthier revenue cycle. As Jason Considine, President at Experian Health, recently shared: “With the power of AI and predictive intelligence, we’re no longer waiting for denials to happen; we’re helping providers proactively prevent them. Tools like Experian Health’s Patient Access Curator and AI Advantage allow healthcare organizations to identify issues at the point of registration and throughout the revenue cycle, so teams can focus on care, not corrections. It’s about working smarter, reducing risk and protecting ​​revenue.” Find out more about how Experian Health’s AI-powered claims management solutions help healthcare providers improve reimbursement rates and reduce denials. Learn more Contact us

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

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

Managing claims efficiently—and reducing denials—remains one of the biggest challenges for healthcare providers. Statistics reveal that 46% of denials are caused by missing or inaccurate data, as highlighted by Experian Health's 2024 State of Claims Survey. For providers, these denials translate into endless follow-ups with patients, staff burnout, rising bad debt (which has increased by 7% year-over-year), and slim revenue margins. Reworking a denied claim costs providers an average of $25 and hospitals $181—an expense that is difficult to justify. Introducing Patient Access Curator: Automated claims accuracy from day 1 Fortunately, there is now a way to ensure claims are processed accurately from the start, without excessive effort: Patient Access Curator (PAC), Experian Health's groundbreaking new tool that uses artificial intelligence (AI) to revolutionize the claims process. As a central component of Experian Health's Patient Access portfolio, this innovative solution automates front-end processes, identifies incorrect data upfront, and resolves inaccuracies in real time, preventing costly claim denials before they occur. Introduced in early 2024, the curation tool is getting the attention of revenue cycle leaders at health systems and laboratories, with good reason.  This article gives a run-down of Patient Access Curator and how it helps providers prevent claim denials in seconds.  On-demand webinar: Reimagining patient access — AI at the epicenter of coordinated benefits management Explore how automation and AI are eliminating manual errors, reducing denials and unlocking millions in recoverable revenue. Built-in AI for more accurate data and seamless claims denial prevention Most issues that lead to denials crop up early in the revenue cycle, when information is missed or captured incorrectly during patient registration. For this reason, it makes sense to focus on denial prevention strategies  on the front end. With so much data to capture, manual strategies are bound to stumble. Unfortunately, many digital tools still require staff to check multiple payer websites and data repositories to verify insurance eligibility and check for any billable coverage that might have been missed. Patient Access Curator takes on these tasks seamlessly, and right within Epic workflows. From patient demographics and eligibility checks to coordination of benefits (COB) primacy, Medicare Beneficiary Identifiers (MBI), and insurance discovery, the system automates these essential processes, providing precise data within moments. This solution ensures data integrity from the moment of registration by replacing manual guesswork with advanced AI-driven technology. This reduces the frequency of denials, minimizes A/R write-offs, and curtails vendor fees. Beyond enhancing efficiency, the tool safeguards the financial health of healthcare providers.  Jason Considine, President of Experian Health, says, "Our mission is to simplify healthcare. Patient Access Curator's advanced AI technology equips providers to address claim denials more effectively and efficiently than ever before."  Say goodbye to manual work with instant eligibility and insurance verification Patient Access Curator simplifies operations for billing teams, healthcare staff and patients. By removing administrative hurdles, staff can focus on patient engagement, rather than spending time on paperwork, phone calls and browsing websites for data. The outcome is improved satisfaction for both healthcare providers and their patients.  "We know this technology is revolutionizing the healthcare industry," shares Jordan Levitt, Senior Vice President at Experian Health. Levitt, who developed the AI-powered data capture technology, explains, "By delivering faster, more accurate results, providers can improve financial solvency while giving staff and patients a better experience."  Gone are the days of asking patients for insurance cards or verifying numbers and dates that might be inaccurate. With this solution, registrars and billing teams can be confident in the data they collect, right from the start.  PAC was created to replace the manual guesswork that often bogs down eligibility and insurance verification processes. From patient demographics and eligibility checks to COB primacy, MBI, and insurance discovery, this solution automates these critical touchpoints, delivering accurate data in seconds.  Fewer denials, faster reimbursements  The impact on denial prevention is unparalleled. Patient Access Curator ensures fewer claim rejections and faster payer reimbursements by identifying and correcting bad data across eligibility, COB, and discovery at the start of the revenue cycle. Providers are left with more retained revenue, which can be reinvested into what truly matters: patient care.  Patient Access Curator: Key features that set it apart Patient Access Curator differentiates itself as a comprehensive, all-in-one product that simplifies the most complex aspects of claims management. Key features include:  Real-time data correction: Fixes inaccurate data instantly without staff intervention.  Comprehensive coverage: Finds and corrects bad data across eligibility, COB primacy, MBI, demographics, and insurance discovery.  Eligibility verification: PAC automatically interrogates 271 responses, flagging up active secondary and tertiary coverage information to eliminate coverage gaps Coordination of Benefits: Integrating with eligibility verification workflow, PAC automatically analyzes payer responses to find hidden signs of additional insurances that may be missed by a human eye, and triggers additional inquiries to those third parties to determine primacy, for faster COB processing  Medicare Beneficiary Identifiers: PAC uses AI and robotic process automation to find and fix patient identifiers so no one misses out on essential support Insurance discovery: For patient accounts marked as self-pay or unbillable, PAC automates additional coverage searches Demographics: The platform can quickly check and correct patient contact information.  Seamless integration: Automatically updates host systems (Epic) with verified and corrected coverage data in seconds.  The results? Fewer clicks, faster workflows, and more accurate billing processes. PAC doesn't just prevent claim denials; it transforms how healthcare teams approach patient access and revenue cycle management.  Proven ROI: How Patient Access Curator delivers $100 million boost to Exact Sciences Explore how Patient Access Curator powered a $100M improvement at Exact Sciences by automating insurance discovery and reducing claim denials. Improve financial health by focusing on patient health By eliminating redundant administrative questions, Patient Access Curator allows patients to focus on their health rather than the complexities of billing and coverage. Meanwhile, healthcare staff enjoy a boost in morale, thanks to fewer manual tasks and more efficient workflows—a benefit that can lead to higher staff retention over time.  Patient Access Curator is more than a tool; it's a game-changer for healthcare organizations looking to protect their revenue while delivering a better, more seamless experience for both staff and patients. Say goodbye to manual guesswork and hello to a smarter, faster, and more reliable way to manage claims. With PAC, healthcare organizations can finally get claims right from the start, without the hassle.  Patient Access Curator is available now - learn how your healthcare organization can get started and prevent claim denials in seconds. Learn more Contact us

Highlights: Payer contract management software helps reduce revenue lost through denied claims and underpayments – two of the biggest pain points for providers – by validating reimbursements, supporting compliance and flagging policy changes in real time. Named "Best in KLAS" three years in a row, Experian Health's contract management tools optimize payer contracts and improve financial performance without adding staff. Experian Health's Contract Manager enabled OrthoTennessee to achieve an 86% success rate on appeals, saving time and recovering thousands of dollars. Claim denials and underpayments continue to cut into provider revenue, making them top pain points for healthcare chief financial officers. In Experian Health's 2024 State of Claims survey, 73% of providers reported an uptick in denials over the previous year, while 77% were seeing more frequent payer policy changes. When contract terms aren't up to date or properly understood, these changes can lead to costly surprises. Many healthcare organizations are turning to claims management automation to improve front-end operations and prevent downstream denials. But could they be overlooking another digital tool? Implementing payer contract management software is a practical way to strengthen early revenue cycle performance and ward off discrepancies that lead to denials. This software helps hospitals and health systems recover hundreds of thousands of dollars annually by auditing payer contracts and identifying underpayments. The role of payer software in enhancing contract efficiency Payer contracts set the terms for how providers get paid. These agreements cover details like claim submission timelines, reimbursement schedules, covered services, reimbursement rates, dispute procedures, contract duration and renegotiation terms. When managed well, they ensure providers are reimbursed accurately and promptly. However, monitoring complex payer contracts is becoming increasingly challenging for providers. According to the State of Claims survey, 43% of providers are very or extremely concerned about receiving full reimbursement. Frequent changes to pre-authorization rules and other payer policies are the main reason for this. Many contracts renew automatically or are amended with little notice, making oversight difficult. "Depending on how the contract is written, providers may receive very little notice of these changes," says Tricia Ibrahim, Director of Product Management, Contract Manager Suite. "Without a way to systematically and efficiently monitor these agreements throughout the contract term, there is simply no way for a provider to ensure they're paid properly." Payer contract management software addresses this by streamlining contract workflows and standardizing how agreements are handled. Built-in modelling tools allow providers to simulate different claim scenarios so they can negotiate terms from a stronger, well-informed position. Dashboards offer real-time insights that help staff ensure compliance, prevent denials and secure proper reimbursement. Key benefits of healthcare payer software for managing contracts A big part of the challenge for providers is that they are often juggling multiple contracts with multiple payers, including private insurers, Medicare, Medicaid and third-party administrators. Each has its own rules, rates and timelines. Without an automated way to track everything, it's easy for revenue to slip away. Payer contract management software helps by: Centralizing all contracts in one place Tracking critical dates like renewals and amendments Flagging changes in reimbursement terms Linking payer terms directly to claims workflows Identifying underpayments by comparing actual and expected reimbursements. This amounts to more than just good record-keeping: these tools offer instant feedback to reduce errors that could trigger denials. Teams save significant time because they no longer need to review contracts or chase down missing payments manually. Frances Thomas, Manager of Payer Strategy at OrthoTennessee, uses Experian Health's payer contract management software to negotiate more favorable settlements and terms with payers. "The system gives us the information we need to be successful," she says. "They can't really argue with you on that." Watch the webinar: See how OrthoTennessee achieved an 86% successful appeals rate with Contract Manager. Optimizing payer contracts with advanced contract management tools A first step in reducing denials and boosting revenue should be ensuring the revenue cycle team thoroughly understands their payer contracts. Contract management systems support this by rooting out ambiguous language, complex reimbursement terms or overly strict coding requirements. By analyzing contracts in detail, these tools identify hidden pitfalls that might go unnoticed until revenue is at risk. Experian Health's Contract Manager and Contract Analysis solution optimizes this process by checking claims before submission, then validating expected reimbursement against allowed amounts. Rates and authorization rules are populated automatically to reduce manual input, while contract mapping and real-time alerts help teams stay compliant. Providers also benefit from extra support through Experian Health's team of contract analysts, who are on hand to review contract terms, fee schedules and payment policies to ensure nothing is overlooked. This end-to-end visibility and guidance is why Experian Health's payer software has been named "Best in KLAS" for three consecutive years. One major benefit for OrthoTennessee was being able to handle claims in bulk. Thomas says, "We had over 600 claims for one day in the wrong network. I was able to take that bulk of claims and handle those. Otherwise, I was going to have to sit there and go claim by claim. It's a huge time saver to work smarter, not harder." Listen in to hear how another Experian Health client, Boston Children's Hospital, used Contract Manager to resolve underpayments and work with payers to resolve issues and errors, resulting in increased revenue. Learn more about how payer contract management software optimizes revenue, ensures compliance and streamlines payer contracts. Learn more Contact us

Healthcare providers have heard it before – high employee turnover and the constant need to train on new solutions can severely impact the efficiency of revenue cycle management (RCM) teams. As denials increase, the resources required to address them grow, putting additional strain on healthcare providers and their teams.  For decades, manual claim management has been the cornerstone of revenue cycle operations. However, with shifting payer algorithms, higher patient volumes, and evolving insurance coverages, this approach is no longer sustainable. Getting the highest percentage of claims paid with the exact amount of human capital is unachievable. Many health systems can't keep up, and RCM teams are experiencing burnout. There is a glaring need for the rapid adaptation of automation to improve front-end data collection, where reducing errors can have the highest impact on claims, and the teams responsible for them. According to Experian Health's latest State of Patient Access survey, 56% of providers say patient information errors are a primary cause of denied claims, 48% report inaccuracies in data collected at registration, and 83% emphasize the urgent need for faster, more comprehensive insurance verification.  Front-end operations are a major source of friction. Four out of the five top patient access challenges reported by providers relate to front-end data collection, including improving insurance eligibility searches, reducing errors and speeding up authorizations. Is it any wonder that these actions are typically performed by hard-working and taxed humans?   These inefficiencies don't just slow down internal workflows. Manual, error-prone processes lead to delays, claim denials and patient frustration, not to mention low morale with revenue cycle teams trying to find the errant data. Providers note that staffing shortages are compounding the problem, which suggests that tackling front-end workflows would be a strategic operational win.  How Patient Access Curator enhances revenue cycle efficiency  What if providers could take that manually laden process, integrate automation, and allow their staff to apply their revenue cycle experience, equity and strategic thinking in the right place?   Patient Access Curator (PAC) uses automation and artificial intelligence (AI) to streamline patient access and billing, address claim denials and improve data quality without the need for human intervention. This integrated solution performs rapid eligibility, coordination of benefits (COB), Medicare Beneficiary Identifier (MBI), demographics and insurance discovery checks to ensure that all data is correct on the front end, freeing teams up to focus on more strategic tasks.   It doesn't require the long training requirement of standalone products; it fits seamlessly into existing EHR systems, and works directly within the system, with no need for drawn-out onboarding programs.   According to one of the early adopters of the Patient Access Curator, their revenue cycle team is already seeing – and feeling – the results of automation.   A Senior Director of Revenue Cycle at a large Midwestern health system says, “One of the primary reasons we chose the Patient Access Curator was because it makes the normally manual work of revenue cycle much easier, which in turn improves productivity, empowerment and morale. Registrars are now able to make determinations right within the system. It's easy to use.” With so much data to capture, manual strategies are bound to stumble and apply downward pressure on those tasked with high-volume work. Patient Access Curator removes the need for manual checks on multiple payer websites and data repositories to verify insurance eligibility, and checks for any billable coverage that might have been missed. Experian Health's industry-leading claims management products are designed to simplify these processes. The  newest denial prevention technology  strengthens this suite with capabilities previously unavailable.  Efficient claims management with artificial intelligence and automation  Patient Access Curator captures and processes patient insurance data at registration using an “if-then” logic that returns multiple data points from a single inquiry, in seconds. Registration staff can leverage this technology to collect and verify much of the information they need to compile an accurate claim, with just a single click. In a matter of seconds, they'll have a comprehensive readout of:  Eligibility verification: PAC automatically interrogates 271 responses, flagging up active secondary and tertiary coverage information to eliminate coverage gaps Coordination of Benefits: Integrating with eligibility verification workflow, PAC automatically analyzes payer responses to find hidden signs of additional insurances that may be missed by a human eye, and triggers additional inquiries to those third parties to determine primacy, for faster COB processing Medicare Beneficiary Identifiers: PAC uses AI and robotic process automation to find and fix patient identifiers so no one misses out on essential support  Insurance discovery: For patient accounts marked as self-pay or unbillable, PAC automates additional coverage searches Demographics: The platform can quickly check and verify patient contact information Patient Access Curator achieves such speedy results “because the underlying code acts like a Rosetta Stone, automatically translating the language of the user and the health system into the terms required by the payer,” says Jordan Levitt, Senior Vice President of Experian Health. “This means data can be transferred easily between interfaces.” Hear how Columbus Regional Hospital has used the Patient Access Curator to simplify and streamline its revenue cycle operations. With Patient Access Curator, better data adds up to increased revenue cycle efficiency, along with the following:   Reduced errors: Automation minimizes human intervention in repetitive tasks.  Faster processing: Automated systems can handle large volumes of claims and payments much faster than manual processes, accelerating the reimbursement cycle, improving cash flow and reducing delays in revenue collection.  Enhanced compliance: Automation tools like Patient Access Curator are continually learning from inputs, and adapt to stay up-to-date with evolving regulatory requirements and payer policies. This ensures that claims are compliant, reducing the risk of denials and costly rework.  Improved denial prevention: Patient Access Curator identifies patterns in historical claim data, flagging or fixing potential errors before submission. This proactive approach helps in preventing denials and optimizing revenue recovery.  Streamlined workflows: Automation frees up staff from mundane tasks, allowing them to focus on strategic initiatives such as patient engagement and financial planning. This leads to more efficient use of resources and improved overall productivity.   At a time when revenue cycles are under increasing pressure from changing payer rules, labor dynamics and operational constraints, this new solution offers a long-awaited boost to both reimbursement rates and productivity. Patient Access Curator is available now – learn how it can help healthcare organizations boost revenue cycle efficiency and prevent claim denials in seconds. Learn more Contact us

Highlights: Healthcare claims processing is becoming more complex, putting financial stability at risk. Many organizations are turning to technology, particularly automation and artificial intelligence (AI), to improve the speed and accuracy of claims processing in healthcare Organizations that modernize their claims systems and track key performance indicators are better positioned to reduce denials and accelerate reimbursement. Healthcare claims processing is getting harder, according to Experian Health's 2024 State of Claims report. For 65% of healthcare leaders, claims management is more complex than before the pandemic. Slower reimbursements, rising denial rates and mounting administrative pressure are putting financial performance at risk. To improve speed and accuracy, many organizations are investing in technology: 45% of providers plan to invest in claims management technology in the next six months. As margins tighten, those that modernize their healthcare claims processing systems will be better equipped to stay financially strong. Understanding the current healthcare claims processing landscape Despite its central role in healthcare finance, claims processing continues to be one of the most resource-intensive and error-prone parts of the revenue cycle. Findings from the State of Claims report highlight three linked challenges that make it tough for providers to get paid promptly: rising denial rates, recurring errors that lead to even more denials, and the growing burden of rework. Denial rates are rising Claim denials are a persistent and growing issue. According to the report, 38% of healthcare leaders said that more than 10% of their claims are denied, and 11% reported denial rates over 15%. These numbers represent not just lost revenue, but significant time spent on rework and appeals. Common causes of denials The underlying reasons for denials are largely preventable. In the survey, 46% of respondents pointed to missing or inaccurate data and authorization problems as key contributors. These issues often stem from manual errors, inconsistent data entry, or gaps in communication between systems and teams. Incorrect insurance details, incomplete patient records and missing prior authorizations all lead to avoidable rejections. The cost of rework is growing As denial rates climb, so does the effort required to fix them. Almost half (48%) of respondents said they review denials manually, with three-quarters of denials handled by someone other than the person who processed the original claim. This puts extra strain on overextended revenue cycle teams on top of delayed payments. Leveraging technology for improved claims management Clearly, there's a need to reduce the manual burden. Comprehensive claims management platforms can help by automating workflows, tracking payer policies and improving claim accuracy at every stage. With claims processing tools designed to streamline decision points and flag potential issues early, revenue cycle teams can work more efficiently and sidestep disappointing financial results. For example, Denial Workflow Manager makes it easier to identify and prioritize denied claims by automating follow-up steps and assigning tasks to the right team members. Enhanced Claim Status submits automated status requests to payers, so staff can respond to pended, returned-to-provider, denied or zero-pay transactions before the Electronic Remittance Advice and Explanation of Benefits are processed. Along with ClaimSource®, organizations can centralize claim activity and apply customizable edits and consistent formatting to reduce errors before submission. Case study: How St. Luke's Health System cut denials by 76% with Enhanced Claim Status Enhancing data accuracy for cleaner claims While many denial management strategies focus on the submission process, achieving clean claims starts much earlier in the revenue cycle. Much of the inaccurate and incomplete patient data that causes so many denials originates at registration. Patient Access Curator addresses this issue by validating critical patient and insurance information at the front end. It pulls data from multiple sources to verify insurance eligibility, confirm coverage details and flag inconsistencies in real time. By resolving errors early on, it prevents incorrect data from flowing downstream into the claim process, resulting in millions of dollars saved. As Ken Kubisty, Vice President of Revenue Cycle at Exact Sciences notes, “You know when the Patient Access Curator went live because you can see it in our stock price. It helped us drive a $100 million bottom-line improvement within two quarters.” On the back end, a tool like Claim Scrubber bolsters clean claim strategies by reviewing pre-billed claims line by line, to catch any remaining errors. Together, this front-to-back accuracy boosts first-pass payment rates and reduces the risk of costly rework. Watch the webinar: Hear how Exact Sciences and Trinity Health used Patient Access Curator to tackle denials and make major savings. Implementing automation and AI to streamline claims processing Once claims are accurate and ready for submission, automation and artificial intelligence (AI) can help organizations work smarter and faster. Nearly half (47%) of providers already using AI consider it a competitive advantage, and it's easy to see why. Predictive tools allow teams to identify which claims are at risk of denial before they are sent, so they can intervene early and avoid costly delays. Tools like AI Advantage™ use AI and machine learning to analyze patterns in claims history and payer behavior. This solution flags claims that are likely to be denied and prioritizes them for review, helping staff focus their time where it has the greatest financial impact. By identifying potential issues in advance, organizations can reduce preventable denials and improve reimbursement rates. Analyzing key performance indicators to stay ahead Even with the right tools and processes in place, consistent results require teams to keep a close eye on performance. Regularly reviewing key performance indicators gives them the insight they need to adjust strategies and stay ahead of claim issues. Metrics like denial rates, clean claim rates and days in accounts receivable show where claims are most frequently getting stuck, where errors are recurring, and where improvements are actually working. While claims processing technology can do much of the heavy lifting, it isn't a set-it-and-forget-it solution. Long-term success depends on constant fine-tuning. Organizations that stay engaged and monitor key metrics closely are better positioned to reduce denials, accelerate payments and improve financial outcomes. Experian Health consultants are also available to help guide these efforts, offering expert support and strategic advice to help claims processing teams get the most out of their investment. Find out how Experian Health's claims management tools help organizations take control of claims processing in healthcare for cleaner claims, fewer denials and faster reimbursement. Learn more Contact us