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.

Denied claims are rising fast, putting revenue and patient trust at risk. Automated claims management and AI-enabled tools are becoming essential for providers to reduce denials, accelerate reimbursements and improve operational efficiency.

Automated authorizations software helped USA Health transform their prior authorizations process – streamlining workflows, decreasing errors and improving staff productivity.

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.

AI is modernizing healthcare revenue cycle management by automating manual tasks, improving data accuracy and reducing denials. This Q&A explores how healthcare organizations can utilize AI-driven tools to strengthen their financial performance.

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.

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

“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