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Key takeaways: Error-prone manual processes are a top reason for delayed reimbursements. Automation across the revenue cycle can help providers see quicker reimbursements. Many processes can be automated: patient estimates, eligibility verification checks, collections, claims management, and more. Prompt reimbursements are crucial for today's healthcare organizations. Delayed reimbursements can lead to a domino effect that impacts the entire revenue cycle. Provider productivity goes down along with quality of care, patients have poor experiences and the bottom line takes a hit. Reimbursement delays often stem from error-prone, outdated manual processes, overburdened staff and excessive administrative work. However, incorporating revenue cycle management automation can help providers overcome numerous reimbursement challenges and improve processes overall. With revenue cycle automation, providers can eliminate many persistent pain points in traditional revenue cycle management (RCM). Staff no longer lose time to tedious manual tasks, patients get their queries answered faster, and managers get the meaningful data they need to drive improvements. And the biggest win? It's easier for providers to get reimbursed for their services, faster and in full. What is revenue cycle automation and how does it work? Healthcare revenue cycle management knits together the financial and clinical components of care to ensure providers are properly reimbursed. As staff and patients know all too well, this can be a complex and time-consuming process, involving repetitive tasks and lengthy forms to ensure the right parties get the right information at the right time. This requires data pulled from multiple databases and systems for accurate claims and billing, and is a perfect use case for automation. In practice, revenue cycle automation involves using technology to complete tasks and processes that may have previously been manually completed. These tasks might include: Automatically generating and issuing invoices, bills and financial statements Streamlining patient data management and exchanging information quickly and reliably Processing digital payments Collating and analyzing performance data to draw out valuable insights. Understanding the challenges in traditional revenue cycle management When it comes to delayed reimbursements, providers lacking revenue cycle management automation typically face the following challenges: Inefficiencies in patient access According to The State of Patient Access 2025, front-end operations are still a source of friction for patients and providers. Four out of the five top patient access challenges reported by providers relate to front-end data collection. Top concerns include insurance searches, reducing errors, and speeding up authorization. Nearly 48% say data collected at registration is “somewhere” or “not” accurate, while 85% report an urgent need for faster, more comprehensive insurance verification. Rising claim denials due to manual errors The State of Patient Access also showed that manual, error-prone processes often lead to delays, claim denials and patient frustration. In fact, more than half (56%) of providers say patient information errors are a primary cause of denied claims. When claims are denied, reworks are often time-consuming, costly and place additional burdens on already overworked staff. Difficulty in managing patient collections Due to rising costs, confusion over estimates and a lack of patient payment options, providers are often left to deal with unpaid medical bills. According to Experian Health data, 29% of patients say paying for healthcare is getting worse. Affordability is a key factor, but patients are also struggling to understand how much their insurance covers and looking for convenient payment options, like payment plans. Download The State of Patient Access 2025 report for a full run-down of patient and provider views about access to care. Six ways revenue cycle automation accelerates reimbursements Revenue cycle improvement through automation can help speed up reimbursements for healthcare providers by: 1. Capturing accurate information quickly during patient access Gathering patient data manually is time-consuming. Errors in the process can lead to denied claims and roadblocks in patient care. Tools like Experian Health's Patient Access Curator use artificial intelligence (AI) to streamline patient access and billing, improve data quality and address claim denials from the outset. This solution also ensures that all data is correct on the front end by checking eligibility, coordination of benefits (COB), Medicare Beneficiary Identifier (MBI), demographics and insurance discovery. 2. Simplifying collections and focusing on the right accounts Healthcare collections are a drag on resources. Automating the repetitive elements in the collections process helps reduce the burden on staff. Collections Optimization Manager leverages automation to analyze patients' payment histories and other financial information to route their accounts to the right collections pathway. Scoring and segmenting accounts means no time is wasted chasing the wrong accounts. Patients who can pay promptly can do so without unnecessary friction. As a result, providers get paid faster. 3. Reducing manual work and staff burnout Chronic staffing shortages continue to plague healthcare providers. In Experian Health's recent staffing survey, 96% of respondents said this affected payer reimbursements and patient collections. While automation cannot replace much-needed expert staff, it can ease pressure on busy teams by relieving them of repetitive tasks, reducing error rates and speeding up workflows. 4. Maintaining regulatory compliance with minimal effort While regulatory compliance may not directly influence how quickly providers get paid, it does play a crucial role in preventing the delays, denials and financial penalties that impede the overall revenue cycle. Constant changes in regulations and payer reimbursement policies can be difficult to track. Automation helps teams continuously monitor and adapt to these changes for a smoother revenue cycle, often with parallel benefits such as improving the patient experience. One example is Experian Health's price transparency solutions, which help providers demonstrate compliance with new legislation and provide extra clarity for patients. 5. Improving the end-to-end claims process Perhaps the most apparent way RCM automation leads to faster reimbursement is in ensuring faster and more accurate claims submissions. Automated claims management solutions, like Experian Health's award-winning ClaimSource®, reduce the need for error-prone manual processes, while improving accuracy and efficiencies in the claims editing and submission process. Additional claims management tools, like Claim Scrubber, also help providers submit more complete and accurate claims. Other tools, like Denial Workflow Manager, can be used if claims are denied. With automation and its extensive data analysis capabilities, work lists are generated based on the client's specifications, like denial category and dollar amount, to identify the root cause of denials and improve upstream processes to prevent them. And as artificial intelligence (AI) gains traction, providers are discovering new ways to use technology to improve claims management. AI Advantage™ uses AI and machine learning to find patterns in payer behavior and identify undocumented rules that could lead to a claim being denied, alerting staff so they can act quickly and avert issues. Then, it uses algorithmic logic to help staff segment and rework denials most efficiently. Providers get paid sooner while minimizing downstream revenue loss. 6. Providing better visibility into improvement opportunities Finally, automation helps providers analyze and act on revenue cycle data by identifying bottlenecks, trends and improvement opportunities. Automated analyses bring together relevant data from multiple sources in an instant to validate decisions. Machine learning draws on historical information to predict future outcomes, so providers can understand the root cause of delays and take steps to resolve issues. A healthcare revenue cycle dashboard is not just a presentation tool; it facilitates real-time monitoring of the organization's financial health, so staff can optimize workflows and speed up reimbursement. Embracing automation for a more efficient revenue cycle Like any business, healthcare organizations must maintain a positive cash flow to remain viable and continue serving their communities. Revenue cycle automation strategies can cut through many of the common obstacles that get in the way of financial stability and growth and speed up reimbursements. Learn more about Experian Health's revenue cycle management technology and see where automation could have the biggest impact on your organization's financial health. 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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

Early diagnostics, remote patient monitoring and personalized care recommendations are just a few examples of how artificial intelligence (AI) is transforming the way healthcare is delivered. As technology advances, so do opportunities to optimize clinical and operational processes. With projected savings in the region of up to $360 billion annually, it's no surprise that 75% of healthcare executives believe AI has reached a turning point in their industry. Yet many providers are still just scratching the surface. Only a small percentage use AI for complex tasks like claim denial management, leaving the competitive advantage wide open. Understanding how these technologies work – and where to apply them for maximum impact – will be crucial to improve efficiency, remain competitive and above all, deliver excellent patient care.  The power of AI in healthcare As the name suggests, artificial intelligence refers to a machine's ability to perform cognitive tasks that would normally be associated with humans, such as problem-solving and decision-making. It can spot patterns, learn from experience and choose the right course of action to achieve a goal. Natural language processing, robotics and machine learning might all be in the mix. AI in the healthcare industry has been found to support applications like: Improving diagnosis through the analysis of medical images AI-powered wearables and virtual nursing assistants Patient data management Reducing and preventing insurance claim denials. Artificial intelligence in healthcare isn't a substitute for human contact, which underpins the best patient care. However, by increasing accuracy and reducing costs, it can help clinicians and healthcare administrators make better decisions that support a positive patient experience across virtually all healthcare settings. AI & automation in healthcare: key benefits  AI and automation deliver results in the three areas that matter most to healthcare organizations: improving the patient experience and care delivery, allowing staff to perform at their highest level, and increasing revenue. Boosting patient satisfaction through speed and accuracy Patient feedback has a few common themes: timely access to care, clearer communication and greater financial transparency. To meet these needs (and improve those feedback scores), healthcare providers should offer patients accurate, upfront information and reduce friction wherever possible. Tools like Patient Access Curator use AI to verify and update all necessary patient information at the front end, all at once, which drastically reduces the time and effort required to manage patient records. This streamlines patient intake and solves for bad data, which prevents claim denials and increases patient satisfaction. Bringing in more revenue by reducing claims errors The 2024 CAQH index estimates that 22% of current costs could be saved by shifting from manual revenue cycle processes to automated ones. Experian Health's State of Claims Survey 2024 suggests providers are eager to capitalize on this opportunity, with 51% seeking to reduce manual work. AI-driven solutions like Patient Access Curator and AI Advantage are designed specifically to meet these needs. Patient Access Curator automates insurance eligibility and coverage, scanning patient documentation for inaccurate information, and uses AI and robotic process automation to reduce manual errors. AI Advantage™ works to prevent denials before they happen, using predictive analytics to flag claims errors and alert staff to claims that fail to meet payer requirements. Improving staff performance by easing burnout The strain of manual processes doesn't just slow down operations. It's also a major cause of staff stress and burnout. Around half of healthcare staff report feeling burned out, costing the industry an estimated $4.6 billion each year. By taking repetitive tasks off busy employees' plates, AI can alleviate overwork and allow staff to focus on higher-value work, improving job satisfaction and productivity. In claims management, for example, AI Advantage, works in conjunction with ClaimSource®, to proactively identify claims with a high likelihood of denial prior to claim submission without staff intervention. This reduces the burden on staff while improving clean claim rates. How AI Advantage and Patient Access Curator improve patient care Experian Health's two flagship AI-based products go even further, offering new ways to use technology to improve patient care: Patient Access Curator uses AI and robotic process automation to streamline one of the most tedious parts of patient intake – verifying insurance eligibility and coverage. By automatically scanning patient records for errors and pulling up-to-date information from payer sources, it eliminates the guesswork and manual labor that bog down revenue cycle teams. The result is faster, more accurate eligibility verification and a smoother experience for both staff and patients. As Ken Kubisty, VP of Revenue Cycle at Exact Sciences, put it: “Within the first six months of implementing the Patient Access Curator, we added almost 15% in revenue per test because we were now getting eligibility correct and being able to do it very rapidly.”  On the back end, AI Advantage – Predictive Denials acts as an early warning system for denials, scanning claims before they go out the door to catch errors and flag risky submissions so they can be corrected in time. Built on advanced AI and machine learning, the platform evaluates claims using historical payment data and real-time payer behavior. Its counterpart, AI Advantage – Denial Triage, picks up where Predictive Denials leaves off, sorting rejected claims according to their potential for reimbursement and prioritizing them based on financial impact. Together, they help providers minimize denials, resulting in faster reimbursement and freeing up resources that can be redirected to patient care. Case study: See how AI Advantage helped Schneck Medical Center achieve a 4.6% average monthly decrease in denials in the first six months. The future of AI in healthcare: what's next? As a quick glance at any newsfeed will confirm, AI's role in healthcare is only going to expand. Predictive analytics will give staff increasingly powerful insights and recommendations to maximize reimbursements, while minimizing the burden on the workforce. AI's ability to continually learn and improve means providers that embrace AI will be better placed to make full use of their data and adapt to the trends and challenges that affect patient care. As expectations grow and resources shrink, AI is likely to be the only way to deliver the scalable, responsive, high-quality care patients deserve. Discover how solutions like AI Advantage and Patient Access Curator use artificial intelligence in healthcare to help reduce claim denials, improve patient access and more. AI Advantage Patient Access Curator

Experian Health's State of Claims survey finds that for many providers, it's getting harder to submit clean claims and taking longer to get paid. More than half say their current technology can't keep up. With revenue at risk, choosing the right denial management software is increasingly important. What features should healthcare organizations look out for to prevent denials and improve financial performance? Why denial management software is essential 11% of respondents in the State of Claims survey said that claims are denied more than 15% of the time, while the administrative cost of submitting and reworking claims continues to rise. Revenue cycle leaders are all too familiar with the challenges driving the denials trend: Frequent updates to payer policies, which make it harder for staff to be sure their submissions comply with the latest rules Incomplete or inaccurate data, such as missing codes or demographic errors, Staffing shortages put pressure on overworked teams, leading to higher error rates and slower response times Reimbursement delays, which tie up revenue and increase the cost of follow-up. Managing these issues is time-consuming and expensive. Speaking to the AAPC, Clarissa Riggins, Chief Product Officer at Experian Health, says that without a robust denial management strategy, providers risk falling further behind. “This growing crisis is a sign that traditional approaches are no longer enough, and providers should adopt more proactive strategies and the latest technology,” she says. Denial management software can help. By automating error detection, tracking payer requirements and helping staff prioritize high-risk claims, it can reduce denials and strengthen overall revenue cycle performance. According to the CAQH, just switching from manual to digital claim submission could save the industry up to $2.5 billion annually. Artificial intelligence (AI) and machine learning, used in solutions like AI Advantage™, can take those savings even further. Key features to look for in denial management software To make a real impact, healthcare denial management software must do more than just track denials. The best solutions offer faster responses, deeper insights and greater efficiency across the revenue cycle. Here are a few core features to seek out: Real-time claim monitoring Does the software alert users the instant a claim is denied? Real-time claim status updates are critical for minimizing delays and missed follow-ups. Automated alerts allow teams to act immediately when a claim is denied, preventing lost revenue and streamlining appeals before a backlog builds up. Tools like AI Advantage can also automatically detect payment pattern changes made by payers, so billers don't have to. Automated workflow  Can it reduce time spent on repetitive manual tasks? Ideally, the software will streamline submissions by auto-populating forms, attaching documentation and routing tasks to the right team members. This minimizes errors, shortens appeal cycles and frees up staff for higher-value tasks. Artificial intelligence Can the platform use AI to prevent denials before they happen (and prioritize the ones worth pursuing)? Experian Health's AI Advantage does this in two ways. First, it uses AI to analyze historical trends to flag high-risk claims before they're submitted, helping teams correct issues early and prevent denials altogether. Second, it identifies denials with the highest chance of a successful appeal, so staff can prioritize their time and improve overall recovery rates. Watch the webinar: Eric Eckhart of Community Regional Medical (Fresno) and Skylar Earley of Schneck Medical Center share how AI Advantage has helped them reduce denial volume, accelerate reimbursement and reduce time spent working low-value denials. Analytics and reporting Does it provide clear insights into why claims are denied? Advanced analytics identify denial patterns across payers, procedures and departments. A tool that offers denial-specific performance indicators, like denial rate, overturn rate and days to resolution will support smarter, faster decisions and long-term process improvements. Keri Whitehead, System Director of Patient Financial Services at UC San Diego Health, explains how AI Advantage gives her team actionable insights to get ahead of denials: Integration capabilities Can it connect seamlessly with current systems? A strong denial management platform should integrate smoothly with electronic health records, practice management systems and billing software. This eliminates data silos, reduces manual data entry and allows staff to work within familiar workflows. Experian Health's “Best in KLAS” claims management solutions can be used to build a single, connected system for greater visibility, fewer duplication errors and faster processing, to prevent denials without adding administrative overhead. Steps to evaluate denial management software Choosing the right claim denial management solution starts with a clear understanding of the organization's unique challenges and goals. Healthcare leaders should consider the following steps during the selection process: Define organizational needs. Identify the most pressing denial challenges, such as high denial rates, slow appeals or limited visibility, and prioritize software that directly addresses those issues. Evaluate integration compatibility. Confirm that the software integrates smoothly with existing systems to avoid data silos or workflow disruptions. Assess scalability. Ask potential vendors about how the solution will grow with the organization and adapt to changing claim volumes, payer mixes and regulatory demands. Review vendor support and training. Look for a partner that offers responsive support, user training and ongoing product updates. Request a demo or trial. The best way to figure out if a new platform will be a good fit for the organization is to see it in practice and let key team members try out its automation, interface and analytics for themselves. Book a demo of AI Advantage to see how it can help providers predict and prevent denials. Best practices for implementing denial management software Once the denial management software has been chosen, the final step is to make sure it's implemented successfully. This calls for good planning, team buy-in and ongoing evaluation. A few best practices to steer the process are to: Engage core teams early to ensure the software fits with their existing workflows and organizational goals. Make sure there's a shared understanding of what success looks like, using KPIs like denial rate reduction or faster appeals to measure performance and ROI. Provide thorough training to equip staff with the skills needed to use the system effectively. Regularly review software performance, denial trends and user feedback to refine processes and settings. By following these steps, organizations can maximize the impact of their new healthcare denial management software and turn a reactive process into a strategic advantage. Find out more about how Experian Health's denial management software, like AI Advantage, helps providers predict, prevent and process denials for faster revenue recovery. Learn more Contact us

Medical billing errors are common problems that can lead to significant financial losses for healthcare organizations. While most medical billing errors are preventable, outdated systems, complex processes and human errors often result in delayed or denied claims. Faced with ever-increasing overhead costs, workforce challenges and growing volumes of data, healthcare leaders will need to implement modern medical billing software solutions to improve revenue cycle management (RCM) medical billing efficiencies, without adding costly headcount or overhead. This article reviews the role modern medical billing software plays in revenue cycle management and how RCM leaders can use it as a top defense to prevent costly claim delays and denials. What is medical billing software in revenue cycle management? Medical billing software is a critical tool healthcare organizations use to streamline patient billing and collections in revenue cycle management. Revenue cycle leaders know that outdated and complex billing processes can wreak havoc on the entire revenue cycle and waste valuable staff time. However, medical billing in revenue cycle management allows providers to optimize the entire revenue cycle — from pre-visit insurance verification and cost estimates through patient billing and collections. Automated medical billing processes in the revenue cycle can help improve efficiencies, reduce errors, and create more reliable collections processes. This allows healthcare organizations to deliver better patient care while protecting their bottom line. How software powered by artificial intelligence (AI) improves medical billing efficiency AI-powered software helps providers manage many types of complex revenue cycle billing processes — from claims management to collections. Providers that embrace AI often benefit from streamlined medical billing processes, fewer claim denials, real-time eligibility verification, better data insights and productivity boosts. For example, AI-powered software can streamline medical billing by automating repetitive tasks, like insurance verification checks, so providers can prevent and catch errors, speed up reimbursements and stretch strained resources. On the front end, with single-click AI-driven data capture technology, running multiple manual eligibility queries is no longer necessary. Now, with solutions like Patient Access Curator, patient details can be verified quickly and accurately. Patient Access Curator leverages AI and machine learning to automatically handle eligibility verification, coordination of benefits, Medicare Beneficiary Identifiers, insurance discovery and more, with just one click. This saves staff hours and reduces human errors that can lead to claims denials and costly delays later on. Ken Kubisty, VP of Revenue Cycle at Exact Sciences, shares how Patient Access Curator helped their organization reduce claim denial errors and added $75 million in insurance company collections. AI-driven predictive analytics solutions, like AI Advantage™, can also help staff identify claims that may be at risk of denial, so potential issues can be handled before submission — saving even more staff time. When admin overhead is minimized, there's less burnout and less stress. Staff can focus on higher-priority tasks, and healthcare organizations can see productivity increase overall. Preventing claims denials with better billing solutions Claims denials are on the rise with healthcare organizations being left on the hook for delayed or unpaid claims. In the State of Claims 2024 report, 38% of survey respondents said that at least one in ten claims is denied. Some organizations see claims denied more than 15% of the time. That's a lot of cost in reworks and lost revenue. Nearly half of providers say patient information errors are a primary cause of denied claims. Errors are common during pre-visit insurance verification due to error-prone manual processes, but can happen at any point during the collection process. Medical billing software helps providers reduce errors and submit cleaner claims right from the start and catch errors before they become costly problems. Here are some of the key ways medical billing software like Experian Health's Patient Access Curator solution helps providers head off claims denials before they happen.   Eligibility checks: Automatically verifies patient eligibility and updates records in real-time to ensure patient information is accurate before claims submission. Coordination of Benefits (COB) verification: Discovers and verifies secondary and tertiary insurance coverage to reduce the risk of COB-related denials while using AI-powered technology to seamlessly integrate with a provider's eligibility verification process. Medicare Beneficiary Identifiers (MBIs): Updates MBIs to confirm patient records are correct and compliant with Medicare requirements while using AI-driven technology and automation to find and correct patient identifiers automatically. Demographics: Patient demographic information is corrected and updated using in-memory analytics and Experian Health's proprietary algorithm to accurately find and fix contact information. Insurance Discovery: Identifies and corrects missing or incorrect insurance information to ensure claims are submitted with the most accurate information available. Discover how Experian Health's revolutionary AI-powered revenue cycle solution is turning denial management into denial prevention. Patient Access Curator solves for missing or correct data in real-time at registration and scheduling, creating a smooth, clean claim process and lowering denials by double digits. Optimize efficiencies in claims management through AI Experian Health customers currently using ClaimSource® can now improve their claim management strategy — before claim submission and after denial. With AI Advantage™ Predictive Denials and Denial Triage, providers can leverage historical claims data and Experian's deep knowledge of payer rules to continuously adapt to an ever-changing payer rules landscape.AI Advantage's - Predictive Denials component reduces denial rates, detects payer changes and empowers staff to focus on highest-priority claims, while AI Advantage's - Denial Triage identifies denials with the highest reimbursement potential and uses AI to segment denials, eliminating guesswork for billers. Watch the video to learn more about the two components that make up AI Advantage, and how healthcare organizations can transform the reimbursement process and decrease claim denials for good. Medical billing software is only getting smarter and faster Upgrading outdated manual medical billing processes results in cleaner claims, improved staff efficiencies, better care and improved patient satisfaction. Today's AI-driven technology brings medical billing in RCM to the next level, enabling time-strapped providers to do even more with less. Now busy providers can streamline manual processes that used to take hours into just seconds. With this new technology, patient information is accurate when claims are submitted, eliminating the need for costly reworks and hits to the bottom line. As more providers adopt AI technology for RCM in medical billing and software solutions get more sophisticated, providers will see new success stories in its power to help healthcare organizations optimize the entire revenue cycle. Learn how tools like Patient Access Curator and AI Advantage can help healthcare organizations prevent claim denials and improve medical billing in RCM. Learn more Contact us

Ask any healthcare revenue cycle manager how they feel about using artificial intelligence (AI), and the response is likely to be “hopeful, but wary.” The potential is clear — fewer denials, faster reimbursements and more efficient workflows. However, with adoption slowing, it seems many have lingering concerns about implementation. According to Experian Health's State of Claims survey, the number of providers using automation and AI in revenue cycle management has halved from 62% in 2022 to 31% in 2024. Despite these reservations, there are bright spots. From preventing claim denials to automating patient billing, AI and automation are already helping many healthcare organizations improve operations, boost financial performance and deliver a better patient experience. This article examines what providers need to know about bringing AI technology into their revenue cycle. Understanding the role of AI in revenue cycle management AI regularly hits the headlines for its clinical applications, like medical imaging analysis, drug discovery and surgical robotics. But behind the scenes, it's also quietly transforming revenue cycle management (RCM). Non-clinical processes like medical billing, claims management and patient payments are complex. Trying to manage these manually results in slow reimbursement and strained resources. AI offers efficient solutions to reshape how providers manage these pressing issues, giving them a head start in coping with increasing costs, workforce challenges and ever-increasing volumes of data. Benefits of AI in healthcare RCM  For most providers, AI's main draw is its ability to deliver significant financial savings. The most recent CAQH index report suggests that switching from manual to electronic administrative transactions could save the industry at least $18 billion. That's a compelling prospect for revenue cycle leaders looking to do more, and faster, with fewer resources. These financial savings aren't just the result of direct cost-cutting – they stem from the broader operational benefits AI brings to the table. These include: Streamlined billing processes: Automating repetitive tasks and minimizing human error reduces costly mistakes that lead to payment delays Fewer claim denials: Predictive analytics help staff identify claims that may be at risk of denial so that issues can be tackled upfront Real-time eligibility verification: AI tools can check a patient's insurance details in an instant, to catch outdated information and prevent billing mistakes and denials Better data insights: AI has the power to analyze vast datasets and find patterns and bottlenecks to help teams improve decision-making Productivity boost: With reduced admin overhead, staff can focus on higher-priority tasks and improve overall performance, with less stress and burnout. The benefits extend to patients, too. Behind every denied claim or billing error is a patient caught in administrative confusion. By automating processes, eliminating errors and increasing transparency, AI and automation help providers give patients financial clarity throughout their healthcare journey. How AI is revolutionizing healthcare RCM  Here are some examples of what this looks like in practice: Using AI to manage complex billing procedures Medical billing errors cost healthcare organizations millions of dollars each week, and the problem is only getting worse. Experian Health's State of Patient Access survey 2024 found that 49% of providers say patient information errors are a primary cause of claim denials, while in the State of Claims survey, 55% of providers said claim errors were increasing. Manual processes make managing the complexity of insurance plans, billing codes and patient payments near impossible. AI simplifies the task. For example, Patient Access Curator uses AI-powered data capture technology, robotic process automation, and machine learning to verify coverage and eligibility accurately with one click. This ensures accuracy throughout the billing cycle, reducing denials and accelerating collections. On-demand webinar: Watch our recorded session to hear how revenue cycle leaders from Exact Sciences and Trinity Health share their strategies and success stories with the Patient Access Curator. Using AI to prevent claim denials Claims can be denied for many reasons, but poor data consistently tops the list. Even so, around half of providers are still using manual systems to manage claims. AI helps providers buck the trend by improving data quality and using that data to improve claims management. Experian Health's AI AdvantageTM, available to those using the ClaimSource® automated claims management system, analyzes patterns and flags issues before claims are submitted, using providers' historical payment data together with Experian Health's payer datasets. It continuously learns and adapts, so results continue to improve over time. Read the case study: AI Advantage helped Schneck achieve a 4.6% average monthly decrease in denials in the first six months. Using AI to reduce patient payment delays The rise in high-deductible health plans is associated with a greater risk of missed patient payments. According to SOPA, 81% of patients said accurate estimates help them prepare for the cost of care, and 96% are looking for their provider to help them make sense of their insurance coverage. AI is vital for providers looking to help patients understand their financial responsibility early and avoid payment delays. With solutions like Patient Access Curator, staff no longer need to sift through piles of patient data and payer websites to verify eligibility and get a clear picture of a patient's insurance coverage. Instead, they can quickly gather the information they need to give the patient a prompt and accurate breakdown of how the cost of care will be split. "Within the first six months of implementing the Patient Access Curator, we added almost 15% in revenue per test because we were now getting eligibility correct and being able to do it very rapidly." Ken Kubisty, VP of Revenue Cycle, Exact Sciences Key AI technologies driving RCM transformation Healthcare revenue cycle managers have long trusted automation to handle repetitive tasks. Hesitancy around AI may stem from a lack of familiarity with its more advanced capabilities. Findings from the State of Claims survey reveal a widening comfort gap, with the number of respondents feeling confident in their understanding of AI dropping from 68% in 2022 to 28% in 2024. So, what are some of the key technologies providers should understand to help bridge the gap? While automation relies on straightforward, rule-based processes to handle repetitive tasks, AI tools are capable of learning, adapting and making decisions. A few examples to be aware of include: Machine learning: Analyses historical data to predict trends like claim denials and payment delays, and use this knowledge to prevent future issues Natural language processing: Extracts actionable insights from unstructured data, such as clinical notes and patient communications, giving staff consistently formatted data to use in RCM activities AI-powered robotic process automation: Goes beyond basic automation to handle decision-based workflows with precision, for example, in evaluating claims information to make predictions about the likelihood of reimbursement. Challenges and considerations in implementing AI in RCM Getting to grips with what AI technologies offer is an important first step for healthcare revenue cycle managers. However, successful implementation also calls for consideration of the practical challenges. Can AI solutions be successfully integrated with existing legacy systems? Will the data available be of high enough quality to drive meaningful insights? Are the costs of implementation within budget, especially for smaller providers? Is the workforce ready to buy into AI, or will extensive training be needed? With careful planning and a trusted vendor, these challenges are manageable. Embracing AI for a smarter, more efficient RCM The benefits of AI in revenue cycle management are clear: more innovative, faster processes that free up staff time and reduce errors, resulting in much-needed financial gains. To maximize AI, providers should begin by reviewing their organization's key performance indicators and identifying areas where AI can add the most value. This should focus on points in the revenue cycle where large volumes of data are being processed, such as claims submissions or patient billing, which are common areas for inefficiencies and errors. By taking a strategic, targeted approach, providers can find the right AI solutions to make the biggest impact – whether it's through curating patient insurance information, improving claim accuracy or predicting denials. A trusted vendor like Experian Health can guide teams through the AI setup and make sure it meets their needs. Find out more about how Experian Health helps healthcare providers use AI to solve the most pressing issues in revenue cycle management. Learn more Contact us

As margins tighten, traditional revenue cycle management strategies are on shaky ground. Many healthcare providers are turning to automation and AI to simplify payments, prevent revenue loss and protect profits. This article breaks down some of the most common revenue cycle management (RCM) challenges facing healthcare leaders and offers a practical checklist to optimize patient access, collections and claims management, while building a resilient and patient-centered revenue cycle. Common challenges in revenue cycle management Revenue cycle management is how healthcare organizations handle the financial side of patient care, from patient billing to claims management. Healthcare providers rely on RCM to ensure they are properly paid, so they can keep the lights on, pay their staff and deliver quality patient care. Are traditional RCM strategies still fit for purpose? Consider some of the current challenges: Patients are responsible for a larger share of costs due to high-deductible health plans. How can providers help them understand their financial obligations and make it easier to pay without hurting their experience? Minimizing claim denials is a daily focus, thanks to constantly changing policies and regulatory updates. How do revenue cycle teams keep up with payers? Staffing shortages remain on the agenda. How can providers ease pressure on staff to maintain productivity and morale? There's also the question of how to turn mountains of data into actionable insights. How do teams interpret it correctly to identify bottlenecks and opportunities for improvement? Automation and AI offer a way through. When implemented thoughtfully, these tools can speed up processes, reduce errors and clear operational roadblocks for a more resilient revenue cycle. The following revenue cycle management checklist includes some of the key questions to consider along the way. Checklist for improving revenue cycle management Automating patient access Can patients book appointments online? Does the online scheduler automate business rules to guide patients to the right provider? Are patient identities verified at registration and point of service? A healthy revenue cycle starts with efficient patient access. According to the State of Patient Access 2024, 60% of patients want more digital options for scheduling appointments, managing bills and communicating with providers. Providers who see improvements in patient access also credit automation, which speeds up intake and improves accuracy. A good first step is to replace paper-based processes with online self-scheduling and self-service registration. These tools make life easier for patients, boosting satisfaction, retention and engagement. Behind the scenes, Experian Health's new AI-powered tool, Patient Access Curator, helps providers get paid faster by verifying and updating patient information with a single click – accelerating registration and paving the way for faster reimbursement. Register now: Exact Sciences and Trinity Health will share how Patient Access Curator is redefining patient access in this upcoming webinar. Optimize patient collections with data and analytics Are patient estimates provided upfront? Are notice of care requirements being addressed? Are patients offered appropriate financial plans and easy ways to pay? With more financial responsibility resting on patients' shoulders, patient collections are under the spotlight. The State of Patient Access report shows that upfront estimates and clarity about coverage are top priorities for patients, because when they know what they owe, they're more likely to pay on time. Implementing tools to promote price transparency and easy payment methods should feature in any RCM checklist. With Coverage Discovery, healthcare organizations can run checks across the entire revenue cycle to find billable commercial and government coverage that may have been forgotten, to maximize the chance of reimbursement. Meanwhile, Patient Payment Estimates offers patients clear, accessible estimates of their financial responsibility before treatment, so that hose who need financial assistance can be directed automatically to payment plans and charity options. Case study: How UCHealth secured $62M+ in insurance payments with Coverage Discovery® Improve claims management to reduce denials Are high-impact accounts prioritized? Are remittances reconciled with payments received? Does claims management software generate real-time insights and reports? With 73% of healthcare leaders agreeing that denial increased in 2024, and 67% saying it takes longer to get reimbursed, claims management is a great use case for automation. ClaimSource®, ranked Best in KLAS in 2024 for claims management, automates the entire claims cycle in a single application. It integrates national and local payer edits with custom provider edits to verify that each claim is properly coded before submission. By focusing on high-priority accounts, providers can target resources in the most effective way to ensure a higher first-pass payment rate. A major advantage for ClaimSource users is access to AI Advantage™. This tool utilizes AI to “learn” from an organization's historical claims data and trends in payer behavior to predict the probability of denial. It also segments denials so staff can prioritize those that are most likely to be reimbursed, reducing the time and cost of manual appeals and rework. Case study: After using AI Advantage for just six months, Schneck Medical Center reduced denials by an average of 4.6% each month, and cut rework time from 12 to 15 minutes per correction to under 5 minutes. Benefits of implementing a revenue cycle management checklist The key to choosing the right RCM tools and technologies is to build the strategy around what patients need most. A clear, transparent and compassionate billing experience is more manageable for patients and helps providers get paid faster. An RCM checklist helps teams stay focused on the tasks that matter. Providers can build on the suggestions above by choosing the key performance indicators (KPIs) that align with their specific goals. Metrics like financial performance, billing efficiency and collections rates can be combined to guide resource allocation, drive improvements and speed up reimbursement. With a well-designed checklist informed by clear KPIs, revenue cycle leaders can keep their teams on track and take their organizations from “surviving” to “thriving.” Learn more about how Experian Health's revenue cycle management tools can help healthcare providers meet current challenges, improve the patient experience and increase cash flow. Learn more Contact us

The growing shift from inpatient to outpatient care continues. The U.S. ambulatory services market was estimated at USD 289.5 billion in 2023 and is projected to grow at a CAGR of 5.38% from 2024 to 2030. A Deloitte study notes that the gap between inpatient and outpatient revenue has been closing for two decades. But what's driving this boom? Clinical advances, patient demand for lower-risk and lower-cost options and payer pressure all play a role. New technologies, like advances in orthopedics, allow more procedures to be performed at outpatient service centers instead of costly hospital settings. Free-standing ambulatory surgery sites are expected to see a 14% volume boost over the next decade as more service lines, like cardiovascular and neurosciences, begin to shift procedures from inpatient to outpatient facilities. The ongoing growth in outpatient services presents a unique opportunity for revenue cycle leaders to use technology to improve outpatient revenue—and the overall patient experience. Grow outpatient revenue with more digital care Patients want a better experience at every step of the patient journey. They want to see their doctor faster, manage appointments online and understand how much it costs—with as little red tape as possible. A lack of streamlined patient access and transparency often results in no-shows, a rise in claims denials, wasted staff time and patient complaints. However, by opening the digital front door, providers can give patients the self-service tools they crave, improve the care experience, keep outpatient schedules full and increase revenue. Additionally, providers can use technology like artificial intelligence (AI) to lower claim denial rates. Here are five strategies to increase outpatient revenue in 2025. 1. Make patient access simple Patients want to see their doctor faster. In Experian Health's latest State of Patient Access survey, eight in ten patients who reported being unhappy with their provider experience cited waiting for an appointment as a top complaint. When trying to schedule, patients are also frustrated by the friction that comes with complex processes, clunky technology systems and sparse provider communication. Outdated manual workflows, staffing shortages and lack of staff training often result in challenges for both patients and providers. Improved patient access is at the heart of patient-centered healthcare. Technology designed to put the patient in control, like online patient scheduling and digital patient intake tools, offer continuous patient engagement, optimized scheduling, and streamlined administrative processes. By leveraging modern patient access solutions, providers can improve patient experiences and alleviate the impact of staffing shortages. 2. Reduce appointment no-shows Missed appointments cause headaches for patients, providers, and revenue cycle managers. Online scheduling and mobile registration are also top of mind for patients. In Experian Health's State of Patient Access 2024 survey, 89% of patients said they wanted self-service scheduling and 85% reported a dislike for filling out repetitive intake paperwork. Online patient scheduling software puts patients in the driver's seat, providing convenient and secure 24/7 access to book, reschedule, and cancel appointments on their own time. Solutions like Patient Schedule sync seamlessly to an organization's scheduling rules, and patients receive automated appointment reminders by text or IVR. On average, providers that use Experian Health's scheduling solution experience an 89% show rate, a 50% reduction in scheduling time, and a 32% increase in patients per month. Patient intake tools like Registration Accelerator simplify mobile registration with a streamlined text-to-mobile experience. Once registration is complete, automated returns of forms, patient-check-ins and demographic information ease the burden on staff. 3. Help patients prepare for outpatient costs Patients need a clear breakdown of their financial responsibility before receiving care. Without it, they may be unable to prepare for care costs appropriately. While hospitals are now required to share detailed pricing for at least 300 common procedures, confusion around a patient's actual financial responsibility still persists. More than half of patients report turning to their provider for help understanding what insurance covers. Digital solutions that provide accurate, upfront estimates empower patients. More than eight in ten patients say pre-service estimates help them prepare for the cost of care. Patient Payment Estimates provide upfront, real-time estimates of what a patient will owe. Providers can offer convenient and secure payment links, and allow patients to pay their bills online or see customized payment plans. Outpatient providers can further maximize the chance of reimbursement by running health insurance coverage checks across the entire revenue cycle. This can help find billable coverage that may have been forgotten and give patients greater certainty about what they'll owe. 4. Automate healthcare collections Collections are often a major challenge in the outpatient revenue cycle. Outpatient procedures can be costly, even with insurance, leaving patients responsible for potentially large bills. Automating healthcare collections allows for faster, more efficient, and more compassionate collections. Tools like Collections Optimization Manager helped Novant Health achieve an overall recovery rate of 6.5% and increase revenue and cost savings to a rolling average return on investment of 8.5:1. With automated tools like Patient Financial Clearance, providers can assess patients' ability to pay and assign them to an appropriate financial pathway. This allows patients to quickly get the assistance they need while freeing up valuable staff time. 5. Streamline claims to increase outpatient revenue Denied claims continue to be problematic for providers. In Experian Health's State of Claims 2024 report, which surveyed 210 healthcare revenue cycle leaders, nearly three-quarters of providers feel claims denials are increasing, while 67% feel getting paid is taking longer. Claims management software can help end the cycle of denials. However, around half of providers still use a manual claims review process, and only 28% feel confident in their understanding of automation, machine learning and AI. Adopting automated and integrated healthcare claims management solutions can reduce errors, prevent undercharges, and ensure a higher first-pass payment rate. Tools like Experian Health's ClaimsSource® simplify the entire claims process, while Claim Scrubber helps providers submit more accurate claims. Digital solutions can also automate claim status monitoring and eliminate manual denial processes. Implementing AI tools to interpret past claims data and recommend next steps can improve outpatient claim denial statistics. Tools like AI AdvantageTM look at past payer behavior and historical claims data to predict and prevent denials. AI Advantage's two components, Predict Denials and Denial Triage, help providers respond to growing denial challenges by identifying claims with a high likelihood of denial before submission, and focus on remits that have the most impact. See how: Find out more about how Experian Health's revenue cycle management solutions can help healthcare organizations increase outpatient revenue, keep pace with growing patient volumes, improve patient satisfaction and boost their bottom lines. Learn more Contact us

Experian Health's State of Claims 2024 report reveals a worrying trend in healthcare claim denials, with nearly three-quarters of survey respondents reporting a rise. Around four in ten say claims are denied 10% of the time, with one in ten seeing denial rates above 15%. Denials at this scale, driven by various claim denial reasons, represent billions of dollars in lost or delayed reimbursements, so it's no wonder that reducing health insurance claim denials tops healthcare providers' “must-fix” list. However, despite being highly motivated to resolve the challenge, many organizations need more support to overcome operational roadblocks. Prior authorizations are taking longer to come through. Payer policy changes are more frequent. Patient information is increasingly inaccurate. For 65% of respondents, submitting clean claims is more complex than before the pandemic. With some wrangling more than three technological solutions and others lacking confidence about using automation and AI, providers seem to be struggling to find the sweet spot when tackling denials. This article looks at the reasons for increased claim denials, as well as how automation and artificial intelligence (AI) can help healthcare providers overcome these obstacles to increase operational efficiency and improve cash flow. Major operational challenges leading to increased claim denials Clarissa Riggins, Chief Product Officer at Experian Health, says that many providers are increasingly concerned that payers won't reimburse costs as denial rates increase, when discussing the State of Claims 2024 report. These concerns reflect operational challenges, including difficulty keeping track of pre-authorization requirements, inability to keep up with rapidly changing payer policies and inadequate front-end data collection. While staffing shortages are not among the top three claim denial reasons as they were last year, they are a continuing drag on efficiency for 43% of providers. Burdened by limited resources, these revenue cycle teams are more likely to make avoidable errors during claim submission—a problem that is affecting the four in ten providers who say they have limited resources to cross-check claims for errors. Riggins suggests that healthcare organizations look to technology to close the claims gap: “We had hoped to see a decrease in claim denials from our previous survey, but it's clear these significant challenges are continuing, adding immense pressure on providers to improve their revenue cycle management processes. This growing crisis is a sign that traditional approaches are no longer enough, and providers should adopt more proactive strategies and the latest technology to navigate this volatility.” Top reasons for healthcare claim denials Here are the top three claim denial reasons and how automation and AI can solve them: 1. Missing or inaccurate claims data Missing or inaccurate claims data is the number one operational challenge responsible for the increase in medical billing claim denials – among the top three challenges for 46% of respondents in the State of Claims 2024 survey. Submitting clean claims relies on getting data right the first time. It calls for speed and efficiency, which is impossible with slow, error-prone manual systems. Yet almost half of the respondents say their organizations are reviewing claims manually. While 54% of respondents believe their technology is sufficient to meet claims management demands, increasing errors and rising denials tell a different story. Revenue cycle leaders who embrace automation in their claims submission and denial prevention strategy set themselves up for smoother operations and a boost to the bottom line. Without the right automation to increase the speed and accuracy of claim submissions, valuable staff time and effort are wasted on manually processing error-prone claims, increasing the likelihood of denial. The lack of automation also places unnecessary strain on staff, diverting their attention from more complex claims issues. 2. Prior authorizations Claim denials often stem from poor communication between payer and provider systems, with the prior authorization process as a prime example. The process requires providers to seek agreement from the payer to cover a service or item before it is administered to the patient. Failure to do so results in the claim for that treatment being denied. Unfortunately, obtaining prior authorizations is not always straightforward; sometimes, the patient's treatment must begin before the authorization process is concluded. Other times, the authorization only covers certain aspects of the treatment. Not only is the prior authorization process complex, but it is also costly, laborious, and time-consuming to navigate successfully. According to the 2023 AMA Prior Authorization Physician Survey, physicians and their staff spend 12 hours per week completing prior authorizations, with almost all reporting physician burnout as a result. Providers must stay on top of frequent changes to payer policies, and staff must use multiple payer portals to track authorization requests. Unsurprisingly, authorizations are among the top three claim denial reasons for 36% of respondents in the State of Claims survey. As with any challenge involving digital systems “talking” to one another, authorizations are a great use case for automation. Automation can be used to check payer policy changes, alert staff when prior authorization is needed, gather relevant documentation, and review authorization requests for accuracy. This significantly reduces the burden on staff and minimizes the risk of claims being submitted without the necessary authorizations in place. Experian Health's Prior Authorizations technology automates authorization inquiries and checks requirements in real time. It uses AI to help users find and access the appropriate payer portal to speed up the authorization workflow. Users will have confidence that they're looking at the same account information and policy details as the payer, which means lengthy negotiations can be avoided. Staff also get accurate status updates on pending and denied submissions so they can take appropriate action and maximize reimbursement. 3. Inaccurate or incomplete patient data Even the slightest mistake or mismatch in a patient's name, address or insurance details can result in a denial, leading to payment delays and extra work for the staff. These denials are particularly frustrating because they should be avoidable. Automation can be used to pre-fill the patient's information before they arrive to avoid the errors that occur with manual input. This has the added benefit of accelerating registration. These solutions can also check for duplicate charges, missing fields and coding inaccuracies. For example, Claim Scrubber helps providers prepare error-free claims for processing by reviewing each line of the claim before it's submitted. ClaimSource® helps providers manage the entire claims cycle by creating custom work queues and automating claims processing to ensure that claims are clean the first time. Implementing technology to prevent claim denials The report details some of the strategies providers are using to try to reduce denials. These include upgrading existing claims process technology, automating or expanding patient portal claims reviews, and automating tracking of payer policy changes. More than half are motivated to adopt new technology to reduce manual input. This is exactly what Denial Workflow Manager is designed to do. It enables providers to track claim status and appeals and quickly identify those that need to be followed up on. It eliminates the need for manual review, while analysis and reporting give staff insights into the root causes of denials to optimize performance. This solution can be integrated with tools like Enhanced Claim Status, which sends automatic status requests based on the type of claim and specific payer timeframes. It generates accurate adjudication reports within 24-72 hours to accelerate the revenue cycle. The output is viewable in ClaimSource to streamline workflows and manage the claims process in a single online application. Automation and digital technology are also valuable counterweights to the shortage of qualified staff. While staffing shortages aren't as high on the list of concerns as in previous years, they remain a stubborn problem. By reducing the need for manual input, claims management can be accelerated while freeing staff to focus their attention where it matters most. Experian Health was client-rated #1 by Black Book™ ’24 in Denial & Claims Management Outsourcing, Health Systems. Learn more AI solutions for reducing claim denials Healthcare organizations can get more bang for their buck from automation by integrating these solutions alongside AI. Interestingly, the survey suggests that providers have mixed feelings towards AI: 35% of providers say they want solutions that leverage more AI and machine learning, yet only 8% are actually using them. Current ClaimSource users might consider AI Advantage™, which uses AI and automation to generate real-time insights for a proactive approach to denial management. It helps providers combat claim denials from two angles: AI Advantage – Predictive Denials uses AI to identify undocumented payer adjudication rules that result in new denials. It identifies claims with a high likelihood of denial based on an organization's historical payment data and allows them to intervene before claim submission. AI Advantage – Denial Triage comes into play if a claim has been denied. This component uses advanced algorithms to identify and intelligently segment denials based on potential value so that organizations can focus on resubmissions that most impact their bottom line. Doing so removes the guesswork, alleviates staff burdens, and eliminates time spent on low-value denials. This solution complements existing claims management workflows to help providers expedite claims processing, reduce denials, and maximize revenue. Another AI-powered solution helps prevent denials on the front end: Patient Access Curator allows patient access teams to capture multiple data points in seconds. This solution solves the “bad data” problem, using AI and robotic process automation to run checks for eligibility, coordination of benefits, Medicare Beneficiary Identifier, demographics and coverage discovery with a single click. The financial impact of denials and the ROI of technology Another paradoxical finding in the report is that while 47% of respondents see having AI technology as a competitive advantage, less than half say they'd be up for fully replacing their existing claims processing technology, even if presented with compelling ROI projections. Automation and AI can meaningfully impact the claims metrics that keep revenue cycle leaders awake at night – denial rates and clean claim rates being the top two. Patients also want to see improved performance when it comes to reducing denials. If healthcare organizations cannot offer a reliable, error-free system, they risk losing patients' trust and loyalty. Providers who demonstrate a well-managed claims system with swift and accurate results will inspire confidence and improve patient engagement. It's essential to assess how existing solutions perform against these metrics and implement upgraded solutions to deliver a more substantial ROI. AI and automation in practice How are Experian Health's clients using AI and automation to reduce claim denials? Here are a few examples: In only six months of adopting AI Advantage for claims processing and reducing claims denial, Schneck Medical Center saw denials fall by an average of 4.6% each month. In addition, the time needed to correct claims dropped from 15 to less than five minutes. The ambulatory clinic Summit Medical Group Oregon implemented Experian Health's claims management solutions, including Enhanced Claim Status and Claim Scrubber, to improve its registration and coding processes. These two solutions helped the team submit cleaner claims, resulting in a decrease in denials. As a result, the company now maintains a 92% primary clean claims rate. Another compelling example of the positive impact of technology on healthcare claims management is IU Health's experience with the all-in-one claim cycle management platform ClaimSource. With ClaimSource, IU Health managed the transmission of $632 million in claims in five days and processed $1.1 billion of claims backlog. Clients who have implemented Experian Health's Patient Access Curator have saved over $1 billion in denied claims, significantly boosting their bottom lines. Experian Health ranked #1 in Best In KLAS for our ClaimSource® claims management system – for the second consecutive year.  Learn more Enhancing revenue cycles by addressing claim denial reasons By pinpointing the most common health insurance claim denial reasons and adopting automation and AI-driven solutions, providers can increase the first-pass clean claim rate, ramp up the likelihood of reimbursement, and reduce the overhead of reworking and resubmitting claims. Inevitably, hospitals will witness a surge in their financial performance. Contact us today to learn how data-driven claims management technology can help your organization reduce denied claims in healthcare and increase ROI. Improve claims management Contact us