Tag: patient access

“Registrars used to wonder, ‘Do I run Coordination of Benefits? Which insurance is primary?’ Now Patient Access Curator does all that work and removes the guess work, and it does it in under 20 seconds.”Randy Gabel, Senior Director of Revenue Cycle at OhioHealth Challenge OhioHealth faced rising denial rates and inconsistent insurance discovery. Registrars relied heavily on what patients told them at check-in, without knowing if that information was complete or current. Forced to make judgment calls about whether to run Coordination of Benefits (COB) or check for Medicare Beneficiary Identifiers (MBI), staff could do little to avoid errors and denials. Randy Gabel, Senior Director of Revenue Cycle at OhioHealth, says, "We were sending claims with the wrong insurance simply because staff didn't know what to do next." They needed a reliable solution to identify coverage upfront – without asking patients to dig out old insurance cards or involving costly contingency vendors. OhioHealth's search became more urgent when a nationwide cyberattack hit the industry in early 2024. They needed a trusted revenue cycle partner to close the gaps in claims and eligibility workflows and prevent denials from the start. Solution To strengthen front-end revenue cycle operations, OhioHealth selected Experian Health's Patient Access Curator® (PAC). This all-in-one solution uses artificial intelligence (AI) and machine learning to check eligibility, COB, MBI, demographics and insurance discovery through a single process. This solution gave staff more accurate data in real-time. Although they had not worked with Experian Health before, the OhioHealth team was immediately convinced that Patient Access Curator fit the bill. Gabel says that during the evaluation, "Patient Access Curator discovered a whopping 18% more insurance on self-pay accounts than our current vendor. No other company or product found that much." PAC fits directly into existing workflows, so OhioHealth's 800+ staff members did not have to learn a new tool or change their daily processes. And with real-time insurance discovery and auto-population of coverage data into Epic, staff no longer needed to rely on guesswork and manual data entry. The tool's ability to automatically determine primacy and remove expired coverage meant staff could submit claims with confidence. "One of the primary reasons we chose Experian and Patient Access Curator was because it makes the manual work of revenue cycle much easier on the registration teams, which in turn improves productivity, empowerment and morale," said Gabel. Outcome When Patient Access Curator went live, the effects were felt almost immediately. Registrars who once spent valuable time debating which checks to run found that PAC handled those decisions automatically, and much faster. Manual searches were no longer necessary, and the system's accuracy drastically reduced the number of errors. These front-end improvements have boosted performance throughout the revenue cycle. Clean registrations meant fewer denied claims, less manual cleanup and faster reimbursements. PAC even uncovered insurance for accounts that had already been sent to collections, helping OhioHealth reduce reliance on contingency vendors and cut avoidable bad debt. PAC continued to prove its value long after it went live. Within the first year, OhioHealth achieved: 42% reduction in overall registration/eligibility-related denials 36% decrease in COB-related denials 69% drop in termed insurance-related denials 63% fewer incorrect payer-related denials $188 million in claims unlocked by reassigning staff and improving productivity What's next? Building on this success, OhioHealth's next steps are to expand their use of PAC by launching a patient financial experience initiative. This will allow patients to complete registration themselves and find their own coverage without waiting for a staff member to become available to help. Resolving more insurance issues upfront will deliver a faster, easier and more transparent registration experience from the start. With Patient Access Curator, OhioHealth has gone from losing time and money dealing with the downstream effects of claims errors to ensuring coverage accuracy at the source – while cutting denials by almost half. Along with a better experience for staff and patients, these gains have created a more resilient revenue cycle, ready to withstand whatever unexpected changes may be in store. Find out more about how Patient Access Curator prevents claim errors before they begin, helping teams submit clean claims and reduce denials. Learn more Contact us

Key takeaways: Billing mistakes and claims delays are common when providers rely on manual patient insurance verification processes. Automated patient insurance verification can speed up eligibility checks and ensure patient insurance and billing information is accurate. Claims denial rates go down and reimbursement rates go up when providers adopt real-time insurance eligibility technology. Patient insurance verification is critical to managing healthy revenue cycles. Without a complete picture of a patient's insurance policy details—like payable benefits, deductibles and co-pay thresholds for out-of-pocket maximums—providers run the risk of non-reimbursement. Yet, many providers still rely on manual insurance verification processes that are often error-prone, resulting in high claims denial rates. Implementing patient insurance verification software helps boost both accuracy and speed, ultimately helping health organizations reduce claims denial and keep revenue cycles on track.  What is insurance verification? In healthcare, insurance verification is the process of confirming if a patient has active medical insurance coverage and finding missing health insurance. Also called an eligibility check, insurance verification typically takes place before a patient receives care, even if they are a long-time patient. During insurance verification, providers check insurance status, coverage details, benefits for medical services and billing details. To keep revenue cycles on track, providers must have the most up-to-date patient insurance information on file to maintain more accurate billing and reduce costly and time-consuming claim denials. Insurance verification also benefits patients by helping them better understand their financial responsibility so they can plan for out-of-pocket costs. Challenges of manual insurance verification processes Many healthcare organizations still rely on manual insurance verification processes to check patient insurance information. Unfortunately, running eligibility checks by hand can result in increased mistakes, a heavy administrative burden on busy staff and higher claim denial rates. Here's a closer look at some of the common challenges of manual insurance verification. Prone to errors Patients typically provide their insurance information when they register or check in for an appointment with a provider. However, this information can be outdated, incorrect or incomplete. According to Experian Health data, nearly half of providers (48%) say data collected at registration or check-in is somewhat or not accurate, and 20% of patients report encountering errors in their medical records and/or billing information. Patients may make mistakes when entering information, switch insurance coverage after filling out their paperwork or forget about secondary coverage they may have. Staff can also incorrectly input patient information from a paper form into a billing system or forget to update a patient's file with new insurance information. Workflow bottlenecks and reduced efficiencies Staff often get bogged down correcting errors or may waste valuable time contacting patients by phone to update insurance information. Billing errors that result from mistakes made during patient insurance verification also create extra work for staff. Inaccurate insurance information may also result in patient confusion about out-of-pocket costs and disrupt care, further jamming up collections and patient scheduling for busy practices. The 2025 State of Patient Access Survey shows that one in five patients face challenges before they even get to see a provider due to data and information discrepancies, while 22% of patients reported experiencing delays in care due to insurance verification. Increased claim denials When providers submit claims with inaccurate or outdated information, it can result in delayed claims processing or denials. More than half (56%) of providers say patient information errors are a primary cause of denied claims. Claims may require rework and resubmission due to outdated billing information, which adds even more delays and burdens staff. Providers may also bill the wrong payer if a patient has unknown secondary insurance coverage and needs to resubmit to the correct provider. Bottlenecks in claims management that result from manual insurance verification create headaches for staff and patients. They also directly impact cash flow, potentially disrupting a provider’s entire revenue cycle. How insurance verification software can improve efficiency When providers leverage insurance verification software, like Experian Health’s Insurance Eligibility Verification solution, there are fewer medical billing errors, cleaner claims submissions and staff are no longer burdened by time-consuming, tedious manual tasks. Automation of eligibility checks: Automating insurance verification throughout the entire patient financial journey ensures cleaner claim submissions, speeds up reimbursement and reduces medical billing errors. Other tools like Experian’s Health’s Coverage Discovery automatically work across the entire revenue cycle, searching both commercial and government payers to find previously unknown coverage, identifying accounts as primary, secondary or tertiary coverage. Real-time coverage and benefits updates: Insurance verification software ensures patient information is always up-to-date. Experian Health’s solution, for example, lets providers access real-time patient reliability data by connecting with over 900 payers. Additionally, its optional Medicare beneficiary identifier (MBI) lookup service can automatically find and validate Medicare coverage—a process that’s commonly done manually. Integration with existing systems and interfaces: Automated insurance eligibility solutions that integrate seamlessly with the tools providers are already using—like claims management and health record systems—accelerate insurance verification, keep patient insurance information up-to-date and allow staff to leverage data analytics to further streamline operations. For instance, Experian Health clients have access to insurance verification tools through eCare NEXT®, which offers a single interface for staff to manage several patient functions. Key features to look for in insurance verification software Healthcare organizations adopting patient insurance verification software should prioritize solutions offering features such as multi-payer support, real-time eligibility checks and analytics tools. As healthcare regulations continue to evolve, especially around price transparency, providers adopting insurance verification software will also benefit from partnering with a solution provider that offers compliance support. Embracing patient insurance verification technology helps providers get paid faster The entire revenue cycle hinges on timely and accurate payer reimbursements. Although often underestimated, the right patient insurance verification solution can be the key to minimizing reimbursement roadblocks and getting claims paid faster. Automating patient insurance checks as early as registration—and at every step along the patient journey—helps providers prevent cash flow issues and reduce long-term revenue losses. Learn more about how Experian Health’s Insurance Eligibility Verification solution can help healthcare organizations reduce eligibility verification errors and accelerate reimbursements. Learn more Contact us

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.   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

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

Manual prior authorization workflows represent one of the most tedious and expensive aspects of the healthcare revenue cycle. However, despite access to automated prior authorization software, only 31% of providers use electronic prior authorizations, according to the Council for Affordable Quality Healthcare (CAQH). The CAQH predicts that providers who switch to automated prior authorization software could not only gain back valuable staff time, but also see significant cost savings. What is prior authorization and why is it important? In healthcare, prior authorizations are when providers and payers decide in advance if a patient's insurance plan will pay for a specific treatment. Prior authorizations are crucial to reimbursements and keeping revenue cycles on track. Providers that offer services without prior authorization are unlikely to receive reimbursement from the patient's insurer. This can result in unpaid medical bills, leaving billing teams chasing patient collections or writing off bad debt. During the prior authorization process, providers submit a rationale for a proposed treatment to the payer. The request is approved or denied based on certain criteria, including payer policies and medical necessity. The payer may reject a prior authorization request if the treatment or service isn't covered under the patient's insurance plan, if it's not considered medically necessary or if a more affordable alternative is available. Simple paperwork errors, like missed deadlines or incomplete documentation when submitting a prior authorization, may also result in a denial. Challenges of manual prior authorization processes Despite the importance of prior authorizations in the revenue cycle, tedious manual prior authorization processes present challenges for many healthcare providers. Some of the key obstacles providers face using manual prior authorization include: Heavy administrative burden Healthcare providers spend a significant amount of time starting, completing and revising prior authorization paperwork. An AMA survey found that 86% of physicians say prior authorization has increased healthcare resource usage. At the same time, additional AMA data reports that providers spend around 13 hours working on 39 prior authorizations each week, and nearly one-third of providers report that these prior authorization requests usually end up being denied. Changing payer policies Keeping up with multiple payers and ever-evolving payer policies adds strain on staff and ultimately results in prior authorization denials. Changes are often unannounced, making it hard for providers to stay on top of updates. As a result, prior authorization submissions aren’t always accurate and may be based on outdated rules. This can lead to instant rejection and wasted time correcting and resubmitting requests. Inefficient workflows Prior authorization requirements can be complicated, especially when providers are juggling different payers, standards and service lines. Coping with these complexities often puts strain on manual systems, especially when multiple staff and notetaking methods are involved. Staff members may each get different pieces of information from payer websites (or over the phone) and not have the ability to benefit from their shared knowledge efficiently. Navigating communication hurdles and rapid payer information changes can result in workflow inefficiencies that snowball quickly. How prior authorization software can improve efficiency Replacing manual prior authorizations processes with automated prior authorization software can help providers improve efficiency. Here are some key ways providers benefit from automated prior authorization solutions, like Experian Health's Authorizations. Reduces manual interventions: This solution limits guesswork, human errors, and misinterpretations by automating data originating from the EMRs. Automation saves staff time and energy and prevents frustration. Stays current with latest payer policies: The prior authorization system stays up-to-date with the latest regulations and payer requirements. Automatic updates provide staff with the most current information, eliminating the need for staff to visit multiple payer websites or cross-check data by hand. Provides real-time updates: Providers can promptly clear authorizations for service by proactively identifying authorization status as pending, denied or authorized. This allows physicians to make timely treatment plans and for patients to avoid disruptions in care. Reduces risk of denials: Through automation, electronic prior authorization software ensures the accuracy and completeness of submissions by automatically checking with payers and vendors to validate that the authorization is on file. Payers and providers also get a shared view of account information, reducing the need for prolonged discussions about the status of authorization and rework requests. Key features to look for in prior authorization software When implementing prior authorization software, look for a solution that offers a wide range of features to automate and streamline the prior authorization process. Experian Health's prior authorization solution, Authorizations, for instance, offers healthcare providers the following key features: Real-time knowledgebase: Access to up-to-date prior authorization requirements and criteria in the National Payer Rulesets Submissions support: Removes guesswork and directs users to the correct payer portal based on procedure Automated inquiries: Automates the prior authorization payer inquiry process Enhanced workflow: Dynamic work queues display status and guides users through next steps Postback: Allows users to easily send authorization status, number and validity dates to health information systems (HIS) and practice management systems (PMS) Image storage: Receives and securely stores payer responses in an integrated document imaging system Reconciliation: Provides insights into authorization variations and helps resolve them, so staff can take proactive steps to prevent denials and appeals Integration with electronic health records and billing systems: Why it matters Providers often choose a prior authorizations platform that seamlessly integrates with existing Electronic Health Records (EHR) and billing systems for maximum efficiency. Solutions like Experian Health's automated prior authorization management tool, Authorizations, easily adapt to existing processes. This eliminates the need for a complete workflow overhaul and minimizes the learning curve for staff. Embracing prior authorization software for a more efficient revenue cycle Revenue cycle leaders who implement prior authorization automation strategies could see significant savings – $494 million annually as an industry, according to CAQH data.  Claims and revenue management processes are often complex and outdated, costing healthcare organizations time and money. High denial rates and slow reimbursements can hurt cash flow and get in the way of financial stability. Automating prior authorization can reduce claim denials, speed up reimbursements and improve the bottom line. Learn more about how Experian Health's electronic prior authorization software, Authorizations, uses automation to achieve greater consistency and efficiency for healthcare organizations. Learn more Contact us

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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Revenue cycle management (RCM) plays a central role in healthcare, influencing both patient access and the financial well-being of providers. As healthcare organizations navigate growing costs, shifting patient expectations, and increasingly complex administrative tasks, they're finding themselves at a crossroads. Experian Health's State of Patient Access 2025 report offers a look at these challenges from the views of patients and providers, while showcasing how technology is changing the way we approach patient access and revenue cycle operations. In this interview, Clarissa Riggins, Chief Product Officer at Experian Health, shares key takeaways from the report, offers actionable solutions for providers, and outlines trends that are set to shape the future of RCM.  Q1: "Let's start with the big picture. What's going on with patients' access to healthcare right now?" Riggins says, "It's stabilizing, which is a good sign. According to The State of Patient Access 2025, 68% of patients and 43% of providers say access has stayed the same. That's the highest it's been since 2022. Only 15% of patients said it's gotten worse, and that's the lowest number we've seen in a few years."  Q2: "That's reassuring. But there are still challenges, right? What are patients struggling with most?"  "The number one issue continues to be wait times," explains Riggins. "About 25% of patients said getting in to see a provider quickly is still a major hurdle. On top of that, 22% reported delays because of insurance verification, and 20% said they ran into problems with errors in their medical records or billing information. So, while some things have improved, there are still gaps to close.”  Q3: "You mentioned insurance verification. How much of a barrier is that?" "It's a big one," she says. "When insurance verification isn't seamless, it creates a domino effect. That 22% figure I mentioned, those are people who had to wait for care because their insurance details weren't sorted out. Automating that part of the process can make a huge difference in getting people the care they need faster.” Q4: "Are digital tools making a difference in these areas?"  "They have the potential to, but adoption is a challenge. 37% of providers said one of their biggest obstacles is getting patients to actually use the tools available. And 55% said patients don't know how to navigate self-scheduling. We're seeing some resistance, but it's not because the tech isn't there. It's more about awareness and ease of use. She continues, "For example, going back to insurance eligibility, Experian Health's Patient Access Curator uses artificial intelligence (AI) to automatically check coverage in real time. This helps providers confirm benefits instantly and spot issues early. That kind of automation takes the guesswork and delays out of the equation, so patients can get the care they need without unnecessary holdups. It's not just more efficient for staff; it literally speeds up access to treatment."  Q5: "Let's talk about cost. How is that affecting access for patients today?"  “Cost is a major pain point," she explains. "The report shows that 34% of patients say they often struggle to pay for healthcare. That number is up from 23% last year. And nearly all patients, 95%, say they at least sometimes have trouble paying. It's clear that affordability is still one of the top reasons people delay care."  Q6: "What can providers do to improve the payment experience for patients?"  “It starts with transparency. Patients want to know what they'll owe before they get care. When 81% of patients say they feel more prepared after receiving an accurate estimate, it shows just how critical that upfront information is," Riggins notes. "Experian Health's Patient Estimates solution was built around this need. It allows providers to give patients clear, personalized cost estimates before they receive care, helping them feel informed and in control." "And 43% said they would consider canceling or postponing care if they didn't get that information," she continues. "That's huge. It proves this isn't just about convenience; it's about access. These tools help patients avoid financial surprises, which can be the deciding factor in whether they follow through with treatment." “This solution isn't just making billing easier. It's directly supporting better health outcomes by making care more accessible and less intimidating financially."  Q7: "So, it's not just about having the tools. It's about how they're used?"  "Exactly. Providers need to make sure the tools are easy to use and that patients understand how to use them. That means clear instructions, mobile-friendly interfaces, and support when people get stuck. If the experience feels complicated, people just won't engage." Q8: "What are patients looking for when it comes to better access?"  "Patients are very clear. They want convenience," Riggins says. "According to The State of Patient Access 2025 report:  82% don't want to complete forms multiple times if their information hasn't changed  80% want to be able to schedule appointments from their phone (via a browser or an app)  77% want a heads-up on insurance coverage before treatment  52% want more digital options, period  So, if providers listen to these preferences and meet patients where they are, access improves naturally."  Q9: "What about billing and patient record issues? How can providers avoid those mistakes?"  "Strong data practices are key. That means better systems to catch errors before they become problems, regular staff training, and giving patients the chance to double-check their records. Adding tools like Patient Access Curator can really make a difference. It uses artificial intelligence to handle a bunch of tasks all at once – eligibility checks, COB, MBI, demographics, and insurance discovery. By automating tasks that are traditionally performed by human staff, healthcare organizations can save time associated with administrative intake and coverage verification. This also means solving for bad data in real-time, which can help prevent billing and claim errors in the long run.  Clean data makes everything easier, from billing to insurance verification to patient trust," Riggins concludes.   Patient access is evolving, but not without its challenges. As the State of Patient Access 2025 report highlights, stability is improving, but issues like price transparency, low adoption of digital access tools and insurance verification continue to create friction. The path forward lies in listening to what patients are asking for: easy-to-use digital tools, clear pricing, and fewer administrative headaches. By utilizing automation and AI, providers can streamline access and build stronger, more trusted relationships with their patients.  Learn more about how Experian Health can help healthcare organizations improve patient access, and download the report for the full survey results.   Download now Contact us

Patient access continues to improve, with both providers and patients reporting steady progress, according to The State of Patient Access 2025. Building on the momentum of the 2024 State of Patient Access survey (when 55% of providers reported better access), 36% now say it has improved even further. Around six in ten patients agree that the experience is the same or better than a year ago. Now in its fifth year, Experian Health's latest annual survey shows how patient and provider perceptions of patient access have changed, and where there's still work to do. In February 2025, more than 200 healthcare revenue cycle decision-makers and over 1000 healthcare consumers were surveyed about their experiences over the previous year. The findings point to three key opportunities for organizations looking to improve the patient experience and boost revenue, which are discussed below. Download The State of Patient Access 2025 report for a full run-down of patient and provider views about access to care. What patients and providers think of patient access (and 3 immediate opportunities) The overall sentiment is encouraging, but there's always room for improvement. The report gives a detailed breakdown of the reasons why respondents think access has improved – or not – and how many respondents gave those reasons. These insights will help providers target their improvement efforts where they matter most. Opportunity 1: Focus on the financial experience 29% of patients say paying for healthcare is getting worse 56% of patients say they need help from their provider to understand what their insurance covers 50% of providers say access is better because patients have more flexible payment options Financial concerns continue to shape the patient experience. Affordability is a key factor in whether patients think paying for care is getting easier or tougher, but it's not the only one. Patients who feel that paying for healthcare has improved cite reasons like being able to understand what their insurance covers, having payment plans that make costs more manageable, and being able to complete paperwork digitally prior to care. Conversely, those with a negative view mention confusion over what they owe, difficulty making payments, excess paperwork and lack of payment plans among their top concerns. To address these challenges, providers can turn to tools that streamline the financial journey from the start. Automating patient financial clearance helps get patients on the right financial pathway as quickly as possible, while segmentation data enables smarter and more personalized collection strategies. Offering flexible payment plans and convenient digital payment options rounds out a financial experience that's easier, more transparent and aligned with patients' needs. Case study: See how UCHealth used automated financial clearance to identify $26 million in charity care. Opportunity 2: Prioritize accurate price estimates 81% of patients say an accurate estimate helps them better prepare to pay 43% of patients say that without an estimate, they're likely to postpone or cancel care 88% of providers say there's an urgency to improve or implement accurate estimates Sticking with the financial theme, the findings suggest that despite ongoing efforts, price transparency in particular still needs some work. While more patients received estimates, accuracy has fallen for a third year in a row. As a result, patients are left uncertain about what they'll owe, prompting some to avoid care altogether. On the flipside, 38% of patients say that understanding the cost of care in advance of treatment made for a better payment experience. With 77% of patients saying it's important that their provider can explain what their insurance covers before treatment, there's a clear opportunity to help patients feel more in control. Not only will this reduce patient stress, but it also builds trust and increases the chance of prompt payments. Almost all patients say they struggle to pay for care at some point, so improving the accuracy of estimates should be an immediate priority for providers. Timely, personalized estimates that reflect the true cost of care will give patients early clarity and avoid surprises later. Experian Health's patient estimates tools use real-time data, including insurance coverage, updated payer contract terms and current provider pricing, to calculate accurate estimates before services are delivered. Patients can receive estimates sent directly to their mobile device or generate estimates through a self-service web-based portal. Opportunity 3: Use automation to improve front-end data collection 56% of providers say patient information errors are a primary cause of denied claims 48% say data collected at registration is “somewhat” or “not” accurate 83% say there's an urgent need for faster, more comprehensive insurance verification Front-end operations are a major source of friction for both providers and patients. Four out of the five top patient access challenges reported by providers relate to front-end data collection, including improving insurance searches, reducing errors and speeding up authorizations. These inefficiencies don't just slow down internal workflows. Manual, error-prone processes lead to delays, claim denials and patient frustration. Providers note that staffing shortages are compounding the problem, which suggests that tackling these front-end workflows would be a strategic operational win. It's also a financial opportunity. In the CAQH's latest Index Report, shifting from manual to electronic transactions for administrative tasks such as eligibility checks, insurance verification and prior authorizations could save the healthcare industry up to $20 billion. Patient Access Curator uses automation and artificial intelligence (AI) to streamline patient access and billing, address claim denials and improve data quality from the outset. This integrated solution performs rapid eligibility, coordination of benefits (COB), Medicare Beneficiary Identifier (MBI), demographics and insurance discovery checks to ensure that all data is correct on the front end. Case study: See how Exact Sciences boosted their bottom line by $100 million with Patient Access Curator The State of Patient Access: From survey to strategy The overall takeaway in The State of Patient Access 2025 is that while progress is heading in the right direction, meaningful opportunities remain, especially when it comes to improving the patient financial experience, price transparency and front-end operations. Going forward, patients want financial clarity and confidence when accessing care. Providers, facing ongoing staffing and operational pressures, need smart and scalable solutions to meet those expectations. Now it's time to take those findings and deploy the right tools and strategies to keep the good work going. Download The State of Patient Access 2025 report to get the full survey results and contact us to see how we help healthcare organizations improve patient access with automation, AI and digital tools. Download the report Contact us

For five years straight, patients responding to the State of Patient Access survey have ranked “seeing a doctor quickly” as a top priority. Unfortunately, 94% of patients are still waiting more than two weeks for an appointment. Too many find themselves stuck in scheduling dead-ends, with unanswered calls, endless hold times and limited options when they finally get through. Providers are working hard to cut wait times, but an aging population, rising rates of chronic conditions and elevated levels of seasonal flu are driving up demand. Failure to manage spikes in patient volumes isn't just a scheduling problem; it has wide-reaching financial and operational consequences. Providers must find more efficient ways to help patients move through the healthcare system more quickly without compromising the quality of care. Could online self-scheduling be the answer? This article looks at how opening the digital front door with patient appointment scheduling software gives patients more control over their health journey, while easing operational strain. Challenges in patient appointment scheduling for healthcare providers Efficient scheduling is the only way to help patients see the right physician at the right time. So, what's getting in the way? Demand outstrips supply — Growing demand for specialists, increasing numbers of older patients, and more people with complex chronic diseases mean there are more patients than available appointments. In some “medical deserts,” there are too few medical providers to support local populations with basic primary care. Staffing pressures — Heavy workloads, seasonal illness spikes and lingering burnout (improving, but still affecting nearly half of physicians) affect staff availability and scheduling operations. Administrative complexity — Specialist care often requires longer visits, specific equipment, or multi-provider coordination, making scheduling more complicated. Poor management leads to bottlenecks and inefficiencies, while reliance on manual scheduling increases errors, double-bookings and delays. Rising patient expectations — When patient volumes are high, keeping patient access running smoothly is challenging. Patients now expect healthcare to function like other service industries, with digital scheduling, same-day appointments and clear communication. Appointment scheduling software is key to delivering on those expectations while maintaining operational efficiency. No-shows and cancellations — Missed appointments create inefficiencies, disrupt workflows and lead to revenue loss, while last-minute cancellations create costly gaps in the schedule. They're a drain on resources that providers can't afford. Without an effective waitlist or rebooking system, providers miss opportunities to help patients and bring in more revenue. Benefits of patient appointment scheduling software in healthcare Self-service patient scheduling tools address many of these challenges by allowing patients to book, cancel and reschedule appointments online and on their schedule. It's convenient for patients, while alleviating the burden on staff. Patient Schedule, Experian Health's online scheduling platform, takes a two-pronged approach. With Patient Schedule – Online Scheduling, new and returning patients can book appointments at any time, from any device. Automated integration with provider calendars and business rules prevents patients from booking the wrong appointment type. It updates immediately when a cancellation occurs, so patients are shown real-time availability and can see their doctor sooner. And for those that need more assistance or prefer to speak to an agent, Patient Schedule – Call Center Scheduling uses sophisticated decision technology to help call center staff schedule faster and more accurately. Automated prompts guide staff through the conversation, so teams can easily find the right providers based on an organization's business rules. Together, these tools allow providers to increase their capacity and improve patient engagement. Discover how IU Health used guided scheduling to transform operations, which resulted in a 114% increase in patient utilization within one year. Patient Schedule by the numbers: Up to 50% reduction in scheduling time, thanks to fast and efficient guided search Staff training is completed in just one hour, so they can start taking calls the same day 89% patient show rate as a result of automated reminders 32% more patients scheduled monthly, as self-scheduling attracts patients and increases market share. The growing importance of patient appointment scheduling software With 89% of patients saying they value the opportunity to book appointments anytime, via online or mobile tools, patient appointment scheduling software is fast becoming a competitive advantage. As more healthcare organizations adopt these automated scheduling tools to streamline booking, reduce no-shows and improve access, those relying on outdated manual systems risk losing patients to other providers and falling behind. Streamlining administrative tasks with digital patient intake solutions The State of Patient Access survey found that 63% of providers offered self-scheduling in 2024, up from 40% in 2022. With a further 16% planning to onboard self-scheduling software, the future looks bright for patients who want to call time on slow and outdated booking systems. However, patient scheduling software is only one piece of the patient access puzzle. When integrated with other automated registration and intake tools, scheduling software reduces paperwork, minimizes errors and accelerates check-in. For example, Registration Accelerator allows patients to complete forms, verify insurance and update their contact information before arrival, while Patient Payment Estimates cut the confusion around medical costs. This means that from the moment an appointment is scheduled, staff can focus on patient care, rather than administrative tasks. With the right digital solutions, patients can take control of these processes themselves – wherever and whenever is most convenient. Find out more about how Experian Health's patient appointment scheduling software can simplify and accelerate patient access. Learn more Contact us