Search Results for: artificial intelligence
Denial management is the process of addressing why healthcare claims are rejected or denied, instead of resolving them after they occur. This article explores denial management strategies, why outdated processes fail and how AI-driven solutions can help reduce denials and streamline workflows.
As the healthcare industry prepares for the implementation of the One Big Beautiful Bill Act (OBBBA), it’s clear that readiness is not one-size-fits-all. Hospitals are leading the way, but most providers will need focused updates to their Medicaid/Medicare processes to ensure compliance and protect revenue. In October 2025, Experian Health surveyed 200 healthcare decision-makers to get a better understanding of their readiness levels, where they’ll be impacted and what they’re focusing on, following implementation of the OBBBA. Here are the results: To prepare for incoming changes from the OBBBA, revenue cycle leaders will need to accelerate their adoption of artificial intelligence (AI) and automated solutions. AI-powered tools, like Patient Access Curator, can help providers streamline insurance eligibility checks and improve claims accuracy. Other tools, like Patient Financial Clearance, can help providers support their patients and minimize risks from uncompensated care. New projections estimate that OBBBA could reduce hospital net patient revenue by $68.6 billion in 2026 and 2027. In this webinar, national policy expert Joel White shares an insider’s look at what’s really happening on the Hill and how revenue cycle teams can prepare before reforms hit. Watch now > Find out how Experian Health's revenue cycle management solutions can help your healthcare organization navigate upcoming regulatory shifts and changes. Learn more Contact us Contact Experian Health Complete the form below to be connected with a member of our Sales team. For Customer Support, including password resets, please visit our Support page.
When it comes to artificial intelligence (AI) usage in the healthcare industry, adoption is steadily gaining momentum as providers explore new ways to utilize this technology in their revenue cycle management (RCM) processes. While full trust in AI remains limited, especially for high-stakes decision-making, confidence is rising. Privacy, security, and implementation costs continue to pose significant challenges. However, providers broadly agree that AI will become a cornerstone of healthcare RCM in the next few years, especially in areas like eligibility verification and patient access. Many also acknowledge that human oversight will remain essential, to ensure accuracy and trust. In October 2025, Experian Health surveyed 200 healthcare leaders to better understand how much they trust AI for decision-making, their biggest barriers to adoption, and where the opportunities lie. Here are the results: AI in healthcare RCM isn’t the future; it’s happening now. Learn how healthcare organizations are using Experian Health’s AI technology to streamline patient access and reduce claim denials. Learn more Contact us Contact Experian Health Complete the form below to be connected with a member of our Sales team. For Customer Support, including password resets, please visit our Support page.
In this guide to healthcare revenue cycle management, learn how healthcare organizations can optimize the revenue cycle process at every stage of the patient journey to increase reimbursements and improve operational efficiency.
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.
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.
“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 Contact Experian Health Complete the form below to be connected with a member of our Sales team. For Customer Support, including password resets, please visit our Support page.