Tag: health insurance

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.

Over the past two decades, U.S. hospitals have absorbed nearly $745 billion in uncompensated care, according to the American Hospital Association. This burden continues to grow as hospitals struggle to verify active insurance. The task is made harder by patients frequently changing jobs, relocating and moving through a fragmented payer system that providers must track and interpret. The result? Missed billing opportunities, delayed payments and unnecessary write-offs threaten not only the hospital's financial stability, but also their ability to provide care to their communities.  Now, the newly enacted "One Big Beautiful Bill Act" adds even more pressure. With sweeping Medicaid cuts and stricter eligibility rules, millions of Americans could lose coverage — and hospitals may face a sharp rise in uncompensated care. Key provisions include:  More frequent eligibility reviews (every six months instead of annually) Higher out-of-pocket costs (up to $35 per doctor visit) New limits on state Medicaid funding (including bans on provider taxes) According to the Congressional Budget Office, an estimated 11.8 million people could lose Medicaid coverage by 2034. These changes shift more financial responsibility to hospitals and patients. Is your revenue cycle team ready for OBBBA? Join us for an engaging and actionable three-part live webinar series to learn how to protect your financial performance before 2026 reforms take effect. Save your spot > But the impact isn't just financial. For patients, undetected coverage can lead to surprise bills, postponed treatment, or even collections, all of which erode trust in the healthcare system. Vulnerable populations, particularly those affected by the latest Medicaid changes, are at the greatest risk of falling through the cracks.   Hospitals are committed to serving their communities, including those who may not be able to afford to pay. To do this, they must recover every dollar they're entitled to. That means identifying coverage wherever it exists, even when it’s hidden, forgotten or misclassified.   That’s where Coverage Discovery comes in. Experian Health's solution uses proprietary data and advanced machine learning to identify unknown or forgotten insurance coverage across the entire revenue cycle — before, during, and after care. Unlike traditional eligibility checks, Coverage Discovery goes deeper. It scans commercial, government and third-party payers in real time; it uncovers primary, secondary and even tertiary coverage that might otherwise go unnoticed. This proactive approach helps providers bill the right payer the first time, which reduces denials, accelerates reimbursements, and minimizes bad debt.  Coverage Discovery identified over $60 billion in insurance coverage across 45+ million unique patient cases in 2024 alone, turning missed opportunities into paid claims. In a time of uncertainty, clarity is essential. Coverage Discovery empowers providers to take control of the coverage gap — not just react to it. By surfacing hidden coverage early and often, hospitals can protect their financial health while improving the patient experience.  Here's how it all comes together:  Learn more Contact us

Tracking down missing health coverage has always been challenging for providers, but proposed changes to the Affordable Care Act and Medicaid could make it even tougher. If the reforms take effect, as many as 13.7 million Americans could lose health insurance over the next decade. With more patients cycling in and out of coverage, many will turn up for care without knowing their coverage status, leaving them at risk for bills they can't afford and exposing providers to denials and revenue loss. Insurance verification has traditionally relied on Social Security Numbers (SSN). As the industry moves away from this approach, providers need faster, more reliable ways to confirm health insurance without SSNs. Health insurance without an SSN? The challenge of missing SSNs in patient records For decades, the SSN was a go-to data point for verifying insurance coverage. In the absence of a national patient identifier, it served as a consistent way to match individuals to their insurance records across health systems and payers. However, many patients do not have SSNs, and concerns about data privacy, duplication and identity theft led providers and payers to phase out SSNs. Although SSNs may still be collected during enrollment for administrative use, industry best practice now discourages using SSNs unless absolutely necessary. Recognizing the need for more secure and trustworthy identifiers, many payers have moved away from SSNs. For instance, in 2018, Medicare replaced SSN-based Health Insurance Claim Numbers with Medicare Beneficiary Identifiers (MBIs). These are now the primary means of checking a person's identity for Medicare transactions like billing, eligibility status and claim status. Commercial health plans have followed suit, relying more heavily on member IDs and internal identifiers for billing and eligibility and avoiding SSNs in patient records in line with privacy rules set out in the Health Insurance Portability and Accountability Act. As a result, SSNs are disappearing from patient records and payer databases. The question for providers is how to accurately verify insurance without SSN access. The impact of unidentified insurance on claims and reimbursement When active insurance coverage is overlooked, providers lose the opportunity to bill for care. Some patients will be incorrectly assigned self-pay status, triggering unnecessary billing cycles or charity write-offs. Others get care without providing their coverage information at the time of care, especially in fast-moving outpatient and emergency departments. Either way, the revenue is at risk in situations like these. Providers lose time and revenue. Teams are forced to reprocess claims, track down retroactive coverage, and appeal denials that could have been avoided. Missed coverage also takes a toll on patients, who now owe more than $220 billion in medical debt. And with cost concerns prompting four in ten patients to consider skipping care when they don't receive a price estimate, missing coverage is more than a paperwork problem – it's a clear threat to health and well-being. Case study: How UCHealth saved over $3.5 million by reducing accounts sent to collections with billable insurance. Strategies to identify health insurance without an SSN As the use of the SSN in medical billing declines, providers are looking for new and better tools to find insurance coverage. Digital technology and data integration make it possible to verify insurance without SSN use. Here are a few of the most effective strategies: 1. Using probabilistic matching and third-party data Advanced coverage discovery platforms now use probabilistic matching to connect patients to payers. These tools analyze data points like name, address, date of birth and phone number to identify likely matches. Instead of needing a patient's exact identifiers, they calculate match confidence based on data quality and historical payer data. 2. Leveraging health information exchanges (HIEs) Another option is to connect to regional or statewide HIEs to check insurance details shared across health systems, payers and public programs. This is especially valuable for transient or underserved populations who often move between providers and may not always carry updated insurance cards. 3. Patient self-service portals with identity validation At the front end, patient self-service tools offer opportunities to collect insurance information before a visit. Identity validation technology helps confirm the person's identity without requiring an SSN. Patients can scan an insurance card, update coverage details or answer verification questions within the portal. This reduces the workload for front desk staff and ensures better data before the patient arrives. Automated tools to streamline insurance discovery While patient access tools help patients confirm their coverage details, automated back-end solutions are essential for identifying insurance when information is incomplete or missing. Intelligent coverage discovery platforms can predict and verify active coverage without relying on SSNs, using demographic inputs like name, address and date of birth. These platforms run real-time or batch searches across multiple proprietary databases, combining search best practices, historical claims data and payer response patterns to flag likely matches. At the point of scheduling or registration, automated eligibility checks help identify billable coverage early, reducing errors, manual work and missed reimbursement opportunities. Experian Health's Coverage Discovery® exemplifies this approach, uncovering commercial, Medicare and Medicaid coverage that may have been unknown or forgotten. By identifying primary, secondary and tertiary coverage, it flags accounts that might otherwise be written off or sent to charity. Not only does this help maximize reimbursement revenue, but it also automates the self-pay scrubbing process and reduces the number of accounts sent to bad-debt collections. In 2023 alone, the platform identified billable coverage in more than 30% of self-pay accounts, resulting in over $25 million in found coverage. This level of automation is especially critical as policy changes continue to disrupt coverage stability. Proactive alerts can flag patients previously marked as self-pay but now linked to valid insurance, helping providers course-correct before claims go unpaid. Better patient matching, better outcomes As insurance coverage becomes more complex, providers need smarter and more efficient ways to verify it. Automated platforms like Coverage Discovery identify active insurance using minimal patient data, improving accuracy and reducing dependence on SSNs. When active coverage isn't found, Patient Financial Clearance helps fill the gap, screening for Medicaid eligibility or identifying patients who may qualify for charity care. Together, these tools give providers a more complete financial picture and ensure patients are connected to the coverage or support they need. The result is not just cleaner claims and faster payments, but better patient and provider outcomes. With more than a fifth of patients experiencing delays in healthcare because of issues verifying insurance information, improving coverage accuracy is a win for everyone. Find out more about how Coverage Discovery can help healthcare providers reduce bad debt by verifying patients' health insurance coverage without SSNs. Learn more Contact us

Finding missing health insurance is critical to keeping revenue cycles on track. Insurance eligibility verification is an important process providers use to confirm active coverage, including additional coverage a patient may have forgotten. According to Experian Health's State of Claims 2024 survey, almost a fifth of providers say missing coverage is a top reason for claim denials. It helps providers determine what insurance a patient has and what's covered and plays a key role in billing. When a patient has more than one type of active coverage, providers use insurance eligibility verification checks to determine how much should be billed to the correct payer and in what order. However, searching for missing coverage is often time-consuming and error-prone thanks to manual systems, disjointed databases and ever-changing payer regulations. When mistakes are made in the early stages of patient intake, it affects every step of the patient journey and revenue cycle. The struggles to confirm patient coverage are likely to worsen as patient volumes increase, medical needs get more complex and staffing shortages continue. Despite these mounting obstacles, insurance eligibility verification checks remain a critical first step to reducing claims denials, improving patient outcomes and minimizing lost revenue. This article explores why insurance eligibility verification checks matter and how providers can adopt new strategies and digital tools to find missing health insurance and prevent revenue from slipping through the cracks. The hidden costs of missing health insurance Today, more Americans are struggling to afford their medical bills — even with insurance. A KFF study reports that 48% of U.S. adults find affording healthcare difficult, while 25% say they or someone in their household had issues covering medical costs in the past twelve months. About half of those surveyed say paying an unexpected $500 medical bill would put them into debt. Insured patients aren't immune from the burden of high healthcare costs, though. Thanks to rising deductibles, co-pays and premiums, patients are taking on more financial responsibility, and 74% are worried about covering out-of-pocket costs. Nearly half of U.S. adults expressed concerns about affording their monthly insurance premiums. When medical bills go unpaid, provider revenue can take a serious hit. Uncompensated care is a huge financial burden for providers. The American Hospital Association reports that hospitals have provided almost $745 billion in uncompensated care since 2000. Patients often have additional insurance coverage that could help close the gaps, but they've either forgotten about it or are unaware of their eligibility. Finding missing coverage is a top priority for providers who want to ensure revenue streams stay in check — especially as healthcare costs continue to rise. Benefits of resolving missing health insurance issues Resolving missing health insurance issues has many benefits for both providers and patients, beyond verifying that services are covered and medical bills are paid. These include: Reduces claim denials: Claims denials are on the rise, and missing coverage is a top reason, according to Experian Health data. Incorrect or incomplete information can result in errors on claim forms or providers sending claims to the wrong payer. Finding missing coverage before claims submission reduces errors, denials, delays and rework. Minimizes wasted staff time: An eligibility recheck is needed when providers discover an incomplete claim, due to a change in active benefits after claims submission. With 43% of providers reporting that eligibility rechecks add at least 10 additional minutes per claim, finding missing coverage in advance is critical to freeing up valuable staff time. Improves the patient experience: Patients are often confused about what insurance covers and what they'll be on the hook for out-of-pocket. More than eight in ten patients say pre-service price estimates help them prepare for the cost of care. When providers are able to find missing coverage during insurance discovery, patients are more likely to receive accurate upfront estimates. Complete and transparent pricing allows patients to prepare for the cost and avoid any surprises, while accelerating collections for providers. Tools and strategies to find missing health insurance Insurance eligibility checks help providers verify insurance status, coverage details and benefits in advance. However, performing insurance checks isn't always straightforward, and often requires searching for missing coverage. Patients sometimes forget to let providers know about secondary coverage or insurance changes. Or, coverage can be forgotten because a patient has moved to a new house, changed states, switched employers or signed up for a different policy. In some cases, patients may be misclassified as self-pay or have only one form of insurance. Providers can improve their insurance eligibility verification process and discover missing health insurance at every stage of the revenue cycle with the following strategies: Implement digital insurance discovery solutions Outdated manual systems are often error-prone and make finding missing coverage a labor-intensive task for already overburdened staff. Automated eligibility verification solutions offer a more streamlined approach to finding missing coverage faster with more accurate results. Tools like Experian Health's Coverage Discovery work across the entire revenue cycle and search government and commercial payers to find previously unknown insurance coverage. Using multiple proprietary data sources, advanced search heuristics and machine learning, it reliably identifies accounts that may be submitted for immediate payment under primary, secondary or tertiary coverage. Watch the video to see how Coverage Discovery helps healthcare providers find previously unidentified coverage – while saving time and money. Streamline patient intake and updates Matching patient information to payer databases starts at registration. However, patient information, including insurance coverage details, can change anytime. Patients may switch insurers, move states or change their contact information. Catching errors before a claim is submitted is key to keeping the revenue cycle moving and collections. Providers often can't keep up with changes or may struggle with tool overload, with nearly 60% of providers reporting using at least two different tools to gather the necessary patient information for claim submission. Digital tools, like Experian Health's Patient Access Curator, can help solve for bad data quality with real-time correction. This solution uses artificial intelligence (AI) and performs eligibility, COB, Medicare Beneficiary Identifier (MBI), demographics and discovery in a single solution, to ensure that all data is correct on the front end. Patient Access Curator also interrogates 271 responses to indicate any secondary or tertiary coverage data. Other tools, like Registration Accelerator, puts the patient in control of inputting and updating information. Using an automated link, patients can enter their personal details and insurance information from their mobile phone or the web-based app, with no login required. Providers can prompt patients to complete registration details during the initial intake process and send reminders to update information that may have changed, like an address or insurance policy, when follow-up appointments are scheduled. Provide accurate upfront estimates The lack of accurate care estimates is an ongoing challenge for both providers and patients. According to Experian Health data, four in 10 patients report spending more on healthcare than they could afford. When providers don't have access to the most up-to-date patient insurance information, or coverage is missing, estimates are often incorrect and patients end up with surprise bills. Inaccurate estimates create a negative patient experience, resulting in unpaid bills and extra work for staff to resubmit claims or chase down collections. However, tools like Eligibility Verification can help providers easily confirm coverage, co-pays and deductibles at the time of service. When armed with real-time coverage data, providers can build more accurate estimates and help patients prepare for the cost of care. How technology makes finding missing health insurance easier 43% of Experian Health's State of Claims survey respondents say that eligibility checks take 10 to more than 20 minutes to complete. Eligibility checks are taking longer, are filled with more errors, and only 54% of providers feel their claims technology can handle current revenue cycle demands. Using technology at every step of the revenue cycle helps providers bridge the gap between front-end eligibility checks and back-end claims management. Digital tools, like Coverage Discovery, fit anywhere into the revenue cycle, allowing providers to easily check for health insurance through the patient journey, not just at registration. Emerging AI and automation tools also help providers find missing health insurance faster. Automated eligibility verification solutions, like Experian Health's Eligibility Verification, seamlessly check insurance benefits across 900 payers using advanced patient matching tools. Patient Access Curator uses AI-based data capture technology to return real-time data in a single click from hundreds of payer responses, allowing providers to quickly verify active coverage, billing information, plan level details, and more. Case studies: See health insurance discovery in practice How UCHealth secured $62M+ in insurance payments and saved $3.5M+ in 2022 with Coverage Discovery How Luminis Health used Coverage Discovery to find $240K in billable coverage each month How Providence Health found $30M in coverage and reduced denial rates with automated eligibility checks Learn more about how automated health insurance discovery helps providers find missing health insurance, reduce claim denials, improve cash flow and deliver better patient experiences. Learn more Contact us

Other blog posts in this series: Segmenting your patient population for the COVID-19 vaccine Engaging patient segments with convenient, secure scheduling solutions Authenticating portal access with automation As the vaccine management process continues to ramp up, providers are focused on how to administer the vaccine to as many people as quickly and efficiently as possible. While certain features like online self-scheduling have helped to speed this process up, especially for those locations that are servicing thousands of patients per day, there are portions of the intake process that are being left behind that will consequently cost providers in the end. We interviewed Dustin Whittier, senior director of product management at Experian Health, about how providers can increase reimbursements for both the vaccine itself and the administration of the vaccine.  How will the volume of patient traffic and offsite administration of the vaccine challenge the reimbursement process? What we’re seeing, particularly at some of these large-scale roll outs, is the entire registration process being stripped. With so many individuals presenting at once for the vaccine, on site staff have significantly less time than usual to collect patient information such as insurance. Many are focused on capturing the bare necessity to quickly and efficiently serve patients. Some are even choosing to forego collecting insurance entirely. Obviously, rushing through the eligibility and insurance process, or bypassing the process itself, will have an impact on a provider’s ability to submit for reimbursement. The ability to confirm identify insurance after the fact may be feasible for a small number of patients, but at this volume, it is nearly impossible. Think of the volume a major vaccine pop-up site might see in a single day, maybe upwards of 20,000 patients. Imagine having a backlog of 20,000 patients to identify and confirm insurance for. It’s a nightmare. What can be done to mitigate these issues? A tool like Coverage Discovery automatically finds available coverage that was previously unknown or forgotten, whether Medicare, Medicaid or commercial insurance. Scans for coverage can be done in bulk, before or after services are rendered, helping providers better identify insurance for patients receiving vaccines. Providers are not only paid faster but can also avoid the collections challenges of self-pay receivables. Watch our interview with Dustin below: Interested in learning more about how Experian Health can help supercharge the COVID-19 vaccine management process?

Sometimes it’s all in the cards. And, in the end, it’s usually not a winning hand for the healthcare organization. In this case, the “card” is the patient’s insurance coverage and the “hand” is the increasing amount of bad debt that can be avoided. For example, a patient presents his or her insurance card at registration. The patient’s employer recently changed plans, and the patient mistakenly pulls out the card for the old plan. The claim is processed using the expired insurance information, and the payer rejects it and reclassifies the account as self-pay. After a time, the account goes to collections, and the patient is sent letters and receives collections calls. Both are ignored because the patient has coverage and assumes the provider simply made a mistake. Unable to resolve the issue, the provider ultimately writes the account off as bad debt. When accounts like this one are misidentified, the healthcare organization loses revenue, time and patient satisfaction. Misclassifying accounts can happen because of registration errors, changing insurance or patient miscommunication. When an account is misclassified, it increases the likelihood the account will turn into bad debt, especially when the account is misclassified as self-pay. Even when caught during the collection process, misclassification errors can impact A/R days, payment speed and cash flow. So, how do you play your cards right? Using the most up-to-date payer data, healthcare organizations can systemically search for current commercial, Medicare and Medicaid insurance coverage. An automated process reveals and prioritizes potential active coverage, allowing staff to rectify any mistakes and file claims in a timely manner. Staff can even proactively identify and correct routine data entry errors, such as incorrect birth dates or transposed Social Security numbers, before the claim is submitted. While the organization improves cash flow and productivity, there also are patient benefits. Using data to identify the right insurance coverage upfront makes patient interactions more efficient. In addition, reduced payment misunderstandings and unnecessary collections calls drive overall patient satisfaction. Curious about how your organization can have a winning collections hand? Use data and analytics to improve the accuracy of upfront business processes and enhance the patient experience. Learn about one of our newest products, Self-Pay Coverage Finder℠, and see how automating the search for insurance coverage can positively impact your organization’s bottom line and the patient’s experience.