At A Glance
Claims management is under pressure as payer changes, data errors and rising volumes drive denials and delays. This guide explains how automation and better data can improve accuracy, efficiency and reimbursement outcomes.Key takeaways:
- Claims managementis a critical component of the healthcare revenue cycle, directly affecting financial performance and operational efficiency.
- Increasing complexity across payers, regulations and patient responsibility is making claims management more challenging.
- Emerging technologies, including automation and artificial intelligence (AI), are reshaping how healthcare organizations manage claims and improve outcomes.
Claims management is one of the most pressing challenges in healthcare billing. According toExperian Health’s 2026 State of Claims survey, 75% are very to somewhat concerned about reimbursement from both payers & patients over the next 12 months. Denied or delayed payments can put pressure on providers’ cash flow.
The survey also suggests that barriers to on-time payment can arise at the earliest stages of the revenue cycle, in the form of incorrect or incomplete claims and patient registration information. Managing claims efficiently starts with the right data.
What is claims management in healthcare?
Claims management is the process of preparing, submitting and following up on healthcare claims, to help providers receive appropriate reimbursement for their services. It spans the entire revenue cycle, from verifying coverage during patient intake through final settlement.
How does claims management fit into the healthcare revenue cycle?
Effective claims management keeps the rest of the revenue cycle on track. But theState of Claims surveysuggests many providers are finding this increasingly tough.
What are the key stages of the medical claims lifecycle?
Each of the following steps is a chance to keep the claim moving:
Patient intake and verification
Staff collect and verify patient demographic information, insurance details and eligibility at patient intake. If crucial data is missed, a denial is likely.Patient Access Curator™ (PAC)addresses this directly, using AI and robotic process automation to automatically check and verify these details.
