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Consumers today want more flexible and convenient access to care, preferably through the self-service experience they are accustomed to in other areas of their lives. To answer this call, providers are turning to online self-scheduling, which allows patients to book an appointment with the provider of their choice any time of day or night via the comfort of their own home and on a mobile device. Incorporating a self-scheduling solution that reaps long-term success takes a specific strategy, and with the number self-scheduling vendors growing every day, it can be hard to know what to look for in a self-scheduling solution. How can providers be sure that their solution is scheduling patients effectively? Implement patient self-scheduling the right way. Online self-scheduling that automates scheduling protocols with customized business rules drives efficiency while ensuring bookings are accurate. If calling to schedule an appointment, schedulers will walk patients through a series of questions to determine the best possible provider and appointment time for their specific care need. The right scheduling solution should be able to seamlessly facilitate that question and answer process online. It not only ensures that patients are being matched with the right provider but keeps providers’ scheduling rules in mind throughout the entire process. For example, some providers may only designate certain days and appointment slots throughout the week for new patients. With those protocols included as part of the scheduling solution, providers can maintain control of their calendars while filling existing gaps.This is particularly vital during a pandemic like COVID-19 where to avoid further exposure and spread of the virus providers may only want to see patients experiencing those symptoms at certain times of day. The benefits are three-fold: schedulers, including call center agents and patients, see only appropriate appointment availability for a provider in real-time allowing them to book on the spot, providers can experience a more predictable schedule as they know their rules are being maintained, and patients can be assured that their health and safety is a top priority for in-office visits. Integrate with your EMR/PM system. Direct integration with any EMR/PM system is a key component for any successful scheduling solution as it provides everyone (patients, providers, health plans, and call center agents) with a continually up-to-date, real-time view of appointment availability. These integrations improve workflows behind the scenes while enabling the patient-centered aspect of the technology, which is the ability to book an appointment from a computer, phone, or tablet. Additionally, being able to provide a non-integrated scheduling experience for affiliated providers and other services is a vital additional offering that needs to be available outside the integration so that systems can open scheduling to all services. Having a solution that can do both is ideal. Offer a white-labeled experience. Customers remember and go back to brands they love, and that couldn’t be truer in healthcare. That is why it is important for organizations to deliver a consistent brand experience across the board—even with a self-scheduling solution hosted by an outside vendor. Leveraging a white-labeled scheduling solution promotes a strong brand experience and builds trust while saving patients the hassle and confusion of leaving the organization’s website to schedule via another. Moreover, many scheduling vendors require logins to their system in order to schedule, this is an unnecessary barrier to patient access. While useful for current or existing patients, a log-in may actually be a detriment to acquiring new patients or those who don’t yet have a relationship with your organization. Provide real-time scheduling (not just request an appointment). Unfortunately, many organizations claim to offer online self-scheduling, but the reality couldn’t be further from the truth. So many times, patients go through the entire online scheduling process to find out that they’ve only requested an appointment, and still have to wait for the provider to confirm and book, more often than not with a phone call which is what the patient was trying to avoid all along. Real-time scheduling means patients have the ability to view and actually choose their preferred appointment day and time and book right there on the spot. This also means that patients can book an appointment any time of day or night, outside of the provider’s business hours. Allow same and next day appointment scheduling. Many providers set aside appointment slots for their patients to schedule same- and next-day appointments for more urgent needs. These slots can be made available to patients online with a scheduling solution’s ability to automate business rules. Offering same- and next-day appointments online holds a few advantages: it’s certainly a competitive advantage against the growing number of standalone urgent care offices, but it also helps mitigate gaps in care as patients are less likely to present elsewhere for care. Send calendar reminders. The act of booking an appointment isn’t always enough to make a patient show up for scheduled care. Automated calendar reminders, specifically, ones that include .ics calendar files, sent to patients immediately after the booking process increase the chances that patients will show for their scheduled appointments. It’s a feature that dramatically reduces patient no-shows, which are often detrimental to the bottom line. Complement with automated outreach. Many health systems send automated phone and text campaigns to patients about their healthcare needs, but all of them still require a patient to call in to schedule an actual appointment. Minimizing the burden on patients could close more gaps in care, improve the patient experience and reduce call center workload at the same time. Automated, targeted outreach campaigns can help you do exactly this. With a simple text message or voice message, providers can prompt patients to book their next appointment right then and there, on the spot, as part of the text message or voice call.With automation, providers can contact and schedule more patients versus leveraging a call center to contact each person individually. And, when automated patient outreach is paired with digital scheduling, patients are far more likely to show up to appointments. Make referral scheduling easy. Providers can arm referral partners with dedicated scheduling links, making it easier for them to schedule certain services. These links can include a customizable Q&A that walks the scheduler through the booking process and allows them to schedule the referral appointment effortlessly and without a phone call. Internal referrals within a provider organization can be similarly managed with a digital scheduling interface. Where patients traditionally would have left the office with a list of providers to call for a follow-up, provider staff can now locate and book follow-up appointments for patients at the point of care before leaving. This not only improves referral capture rate but offers a better, more connected experience for patients as they can more easily navigate the continuum of care and, ultimately, achieve better health outcomes. Include availability on third-party scheduling sites. As providers open the digital front door to their practice, they will want to meet patients wherever they are online, outside of just the provider’s website. A sophisticated online scheduling solution will enable providers the ability to add scheduling links on third-party websites so that patients searching online for local providers or specialists can immediately see appointment availability down to specific days and times.Also, to ensure accurate bookings, the scheduling solution must be able to ask patients questions to ensure they qualify to book, ensuring that the provider’s calendar is protected while making access easier. Leverage analytics to understand your users. Where are patients dropping off during the scheduling process? What is the conversion rate? How many patients are actually showing up for their scheduled appointments? These are all important questions for providers to ask when gauging the effectiveness of their scheduling solution. The answers to each of these questions can refine and improve the scheduling process, and a sophisticated self-scheduling solution will come with real-time analytics dashboards and data science capabilities to help determine opportunities for improvement.Analytics and reporting can also be used to track capacity and utilization rates to help providers optimize their calendars and referral pathways. Analytics can provide insight into where referrals are being sent so that bottlenecks can be quickly and easily identified, and the behavior modified to better spread referrals across the network. The rise of consumerism in the healthcare industry is no doubt influencing the creation and adoption of self-scheduling solutions, among other digital technologies that improve patient access. As these technologies are more seriously considered, providers need to be aware of what to look for in a self-scheduling solution. Smart technology that incorporates the components above will stand out from the crowd, ready to fit the unique needs of any provider organization. Download our free guide to learn more about online self-scheduling and how it fits within an omni-channel access strategy.
This article addresses what a unique patient identifier is, how it’s used in healthcare, and ways they can improve the patient experience.
Health plans have been fighting against inaccurate member data, incomplete member profiles and duplicate records for years. Without a watertight way to keep track of patient identities so health data is reliably linked and accessible across multiple services, payers can’t always be confident that the record in front of them matches the member they have in mind. The pandemic has brought this into sharp focus: positive COVID-19 test results aren’t always following members from service to service, and as the vaccination program rolls out, knowing who has had the disease and who has been vaccinated could be difficult to monitor. As health data expands exponentially and the need to share and connect member records becomes more urgent and complicated, the challenges facing health plans will only grow. Could a unique patient identifier (UPI) be the answer? 4 member matching challenges that health plans could solve with a UPI 1. The healthcare ecosystem lacks 21st Century Cures Act data coordination The lack of integrated systems to transfer member data securely contributes to safety issues, payment delays and potential audits and fines. Over a third of denied claims for health systems result from inaccurate patient information, costing them at least $6 billion per year. While this would seem not to impact the payer, the inability to properly link claims to members could lead to an inability to understand the risk represented by the members being covered. Or worse, an inability to anticipate and monitor trends in members health and provide proactive healthcare options. A unique patient identifier can connect the dots between different parts of the healthcare ecosystem so duplicate and incomplete member data can be detected and eliminated. With a more complete picture of who a member is, health plans can make decisions based on accurate information and exchange data safely and securely. There’s a far lower risk of acting without knowing about recent treatment or test results, or communicating using the wrong address (or even to the wrong member). 2. Healthcare providers have outgrown traditional matching tools With the volume and variability of health data to be matched, traditional matching tools are no longer fit for purpose. For example, an enterprise master patient index (EMPI), which links all versions of a patient’s record across several facilities, may seem reliable. However, by relying on a single source of demographic data, EMPIs likely replicate errors and outdated information, and may combine records for patients who share certain demographic information (for example, if two patients have similar names and the same date of birth). Instead, payers should consider a matching solution that combines member roster information with comprehensive third-party reference data. Member records are matched using referential and probabilistic matching, and connected using a UPI. This gives health plans a more complete picture of their members, built on reliable health, credit, and consumer data sources, and allows all parties to understand the person at the center of it all. 3. Discrepancies in member data make care coordination impossible Members may use different names or nicknames, their address may change, and they may even share a Social Security Number (SSN) with someone else. How can health plans help to coordinate care if they’re not sure they’re tracking the right member? A single electronic health record (EHR) can follow the member throughout their healthcare journey with a UPI, so health plans can be confident that the person on the phone or in the office matches the record on screen. They can monitor and respond to gaps in care, allowing them to better coordinate care for better patient health, improved member engagement and money-saving operational efficiencies. 4. Members present to multiple facilities, inhibiting care plan tracking How can health plans reliably track medication adherence, especially when members present to multiple locations? Is there really a gap in care, or did the member just attend a different facility? And if members go to different pharmacies, how can a pharmacist be sure the prescription is going to the right person? All of this can create risks to patient safety and increased costs for payers. A UPI can help. Experian Health has teamed up with the National Council for Prescription Drug Programs (NCPDP), which sets standards for pharmacy services to exchange electronic healthcare data. A framework has been built for a UPI-based patient matching solution that the entire US healthcare network can use. Not only will this improve patient safety, it’ll minimize staff time spent on reconciling incorrect records, thus boosting financial performance too. When it comes to mismatched records, prevention is better than cure. With a Universal Identity Manager, health plans can have confidence in the accuracy and security of the data they’re using and sharing, promote patient safety, and improve staff productivity. Contact us to learn more.
Experian Health is very pleased to announce that we've ranked #1 in the 2025 Best in KLAS: Software & Services report, for our Contract Manager and Contract Analysis product, for the third consecutive year. Contract Manager, when paired with Contract Analysis, empowers healthcare providers by ensuring payers comply with contract terms, identifying and recovering underpayments, and arming them with real claims data to negotiate contracts. This enables providers to negotiate more favorable terms and maintain financial stability. Clarissa Riggins, Chief Product Officer at Experian Health, says, “In the ever-evolving healthcare landscape, our Contract Manager solution has once again been recognized as the #1 Revenue Cycle Management tool by KLAS for the third consecutive year. This prestigious ranking underscores the significant value our solution delivers to our clients by identifying underpayments and facilitating revenue recovery. We are honored to continue supporting our clients with innovative solutions that drive financial success and operational efficiency.” Learn more about how Contract Manager and Contract Analysis can help your healthcare organization validate reimbursement accuracy, recover underpayments and boost revenue. 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
The denial challenge is getting tougher. In Experian Health's latest State of Claims 2024 survey, almost three-quarters of healthcare administrators agree that claim denials are increasing. The majority also agree that difficulties with claims—like reimbursement times, errors, and payer policy changes—are becoming more common. It's no surprise that denial prevention is a priority for 84% of respondents. However, many organizations still focus on reactive strategies, like working harder with denial management teams or appealing claims once the denial comes through. These efforts have their place, but they only address the problem after it occurs. It's a time-consuming, costly and ultimately inefficient way to face the denial challenge overall. A better approach is to figure out how to prevent claim denials in the first place. This article looks at how to build a proactive denial prevention strategy using automation and artificial intelligence (AI), to streamline claims processing and nip denials in the bud. Understanding denial prevention in healthcare Preventing denials starts with understanding the “ins and outs” of the claims process, particularly payer requirements. Denials occur when a payer refuses to reimburse a provider for services rendered, often due to avoidable coding errors, missing documentation or procedural mistakes. When that happens, providers are left to rework the submission or look elsewhere – most likely to the patient – to fill the funding gap. Many are simply written off to bad debt. To avoid receiving an 835 file with the dreaded claim denial notice, providers must focus on the root causes of denials and get ahead of the pitfalls. The importance of claim denial prevention With denial rates exceeding pre-pandemic levels, 42% of survey respondents say the economy and declining consumer confidence make payer reimbursements more urgent. While financial stability is the obvious driver for getting claims right the first time, denial prevention also improves operational efficiency and reduces the billing and coding staff workload. Denials are frustrating for patients and staff. When claims are processed correctly the first time, providers avoid delays and billing complications and reduce patient stress over unexpected costs. Preventing denials is critical for maintaining trust and ensuring patients feel secure about their financial obligations. How to prevent claim denials Denial prevention strategies should start with addressing the underlying causes of denials. Here are five denial prevention strategies to consider: 1. Improve data accuracy from the start Garbage in, garbage out. If patient information, insurance eligibility, prior authorizations and billing codes are input incorrectly or missing altogether, providers will continue to submit error-filled claims that have no hope of being paid. Tools like Registration Accelerator and Patient Access Curator can verify relevant data for accuracy before claim submission and reduce the risk of denial. 2. Use AI and automation for efficiency If there was ever a case for using automation and artificial intelligence, it's in claim denial prevention. However, around half of providers are still using manual processes, leaving them playing catch-up to the payers who are already using AI to work at scale. Only 10% have automated the process, using AI to correct and resubmit claims. Tools like ClaimSource® can automate eligibility verification and coding, perform error checks before submissions and ensure claims meet payer requirements instantly. This cuts the time and effort wasted on manual processes, releasing staff to focus on activities that need human attention. 3. Automate pre-claim scrubbing to catch errors A great use case for automation is in providing an extra pair of eyes to pore over claims and catch common errors like missing data and wrong codes before submission. Experian Health's Claim Scrubber analyzes claims line by line to ensure that claims are submitted to payers and clearinghouses without errors, increase first-time pass rates and prevent rebilling. 4. Track performance for ongoing improvement Every denial prevention strategy should include monitoring and reporting. Tools that offer real-time tracking of key performance indicators such as denial rates, clean claim percentages, resubmission times, and the reasons for denials can help staff identify patterns. With these insights, they'll have complete visibility into any recurring problems clogging up their claims processes. 5. Outsource to a trusted vendor for extra support and expertise Finally, providers might consider outsourcing denial prevention to a specialist vendor who can help them develop the right strategy and toolkit to streamline billing, improve data integrity and manage claims to ease pressure on internal resources. Experian Health was client-rated #1 by Black Book™ ’24 in Denial & Claims Management Outsourcing, Health Systems. Learn more Proactively reducing claim denials These strategies raise an important question: can existing revenue cycle technology handle the increasing volume of denials? Healthcare administrators aren't convinced: only 54% of survey respondents feel their organization's technology is sufficient to meet demand, down 23 percentage points since 2022. To implement these denial prevention strategies effectively, providers may need to consider upgrading their toolkit rather than relying on traditional systems. Experian Health offers two AI-powered solutions that help providers better predict and prevent denials: Prevent denials with Patient Access Curator Too many denials originate in patient access, so prevention must start here. Patient Access Curator uses AI-driven data capture technology to verify patient details quickly and accurately. With a single click, PAC can automatically check eligibility verification, coordination of benefits, Medicare Beneficiary Identifiers, coverage discovery and financial status. Running multiple manual queries is a thing of the past, saving staff hours and propagating clean data throughout the entire revenue cycle. Watch the webinar to learn more about how Patient Access Curator helps prevent denials with accurate data from the start. Predict denials with AI AdvantageTM Clean data sets the stage for denial prevention, but AI adds an extra layer of protection by forecasting potential issues before it's too late. AI AdvantageTM does this in two ways. First, the Predictive Denials component analyzes claims using the provider's own ClaimSource® data and alerts staff to high-risk claims so errors, inconsistencies or missing documentation can be corrected before submission. Next, the Denial Triage component prevents missed revenue opportunities by segmenting denials and guiding staff to those worth reworking. See how AI Advantage works: If providers can't prevent denials, they can't protect their bottom line. With the right data analytics, automation and AI, providers can take control and spot issues before they become problems instead of spinning their wheels in endless rework. With more advanced tech on their side, it's possible to close the gap with payers and prevent denials, but it also gives staff the headspace to focus on patient care and support. Find out more about how Experian Health's Claims Management solutions help providers build effective denial prevention strategies and reduce lost revenue. Learn more Contact us
