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The rates for closing gaps in care are some of the most widely used, quantitative metrics to measure quality, allocate incentives, and control costs. Unfortunately, health plans face numerous obstacles closing gaps in care, from social determinants of health to inconsistent coordination of care, and don’t always have a care gap closure program in place. Thankfully, digital solutions like web-based scheduling and automated outreach can help health plans jump many of these hurdles while also helping to close gaps in care. Call center schedulingMany health plans are still grappling with the difficulty of three-way scheduling calls between themselves, members and providers. Calls are lengthy and cumbersome as agents dig through binders of provider schedules and scheduling rules to determine and book the right appointment for each member. Members are often put on hold, sometimes more than once, and are much more likely to drop out of the scheduling process entirely when faced with this experience. As a result, these members may face significant care delays, or in some cases miss their necessary follow-up care entirely. With web-based scheduling, member engagement call centers can eliminate three-way calls. Guided search helps to narrow down the right provider for each member and the scheduling platform allows for immediate, on-the-spot appointment selection. Health plans can more efficiently close gaps in care as members can quickly and easily schedule their appointments. This has proven to cut call times in half, and increase scheduling rates by 140%. To learn more, read this case study. Automated OutreachHealth plans typically have a list of individuals to follow up with on a regular (bi-weekly or monthly) basis to book whatever care service is needed to close the gap in care. Now, health plans have the ability to automate this outreach via interactive voice response (IVR) or text message (SMS) while simultaneously enabling members to schedule appointments on-the-spot, either through a link in the text or during the IVR call. The automation improves the member experience with convenient access and helps close more gaps in care – all without a single call center agent. The ultimate combination for closing gaps in careUsed alone, automated outreach and call center scheduling are both effective for closing gaps in care. When used together, health plans can fast track the path to closing gaps in care and further improve efficiencies. Members can first be reached via automated outreach, prompting the individual to schedule an appointment. This allows members the opportunity to self-schedule and essentially self-close their gap in care, without a single live agent phone call. From there, call center agents can pinpoint the members who didn’t schedule as part of the outreach campaign and then call them directly to book the necessary care. We know that despite the flexibility and convenience offered by digital solutions, like automated outreach, there are still individuals who prefer to schedule over the phone and have personal interaction when booking care. The combination of web-based scheduling and automated outreach enables omnichannel access for health plans while helping call center agents focus their attention on the members who need their help most. Contact us to learn more about how Experian Health can help health plans fast track the path to closing gaps in care.

The age of consumerism has been a catalyst in the shift towards patient-centered care, driving hospitals and health systems across the board to evaluate and improve their current methods of patient access. For one multi-specialty medical group, fast and easy access to care meant providing strategic tools for patients to use beyond the four walls of the organization and outside of the traditional hours of the practice. In order to provide a more flexible and convenient method to access care, CareMount Medical, the largest independent multi-specialty group in New York State, turned to Experian Health to enable online self-scheduling. With it in place, patients now have the ability to schedule an appointment online, across any specialty, any time of day or night. Providers’ scheduling protocols are automated within the solution to accurately match patients with the right provider and appointment based on care need. Those same protocols are also used to prevent overbooking, allowing providers to maintain close and comfortable control over their calendars. Improved call center efficiencies. Automated scheduling relieves call center staff of the associated administrative work, allowing more time for nurses and other credentialed staff to answer health questions and concerns over the phone. Increased patient acquisition and retention. In addition to attracting new patients, the solution has proven valuable for patient retention. Since implementation, the organization has seen on average 30 online appointment bookings per provider per month. Higher patient satisfaction. Patients are no longer required to call to schedule an appointment during office hours. This level of convenience gives patients more control over their day and has contributed to rising patient satisfaction scores for the organization as a whole. Continued Improvements. Real-time analytics and dashboards provide direct line-of-sight into scheduling activity, helping leaders at CareMount Medical to both identify areas for improvement and fine-tune the process to further improve online bookings. “Experian Health’s guided search and scheduling solution adds immediate benefits for our patients, supporting our commitment to provide our patients with cutting-edge technology in the convenience of their home.” — Scott D. Hayworth, MD, FACOG, President & CEO, CareMount Medical Learn more about CareMount Medical’s journey and how your organization can also improve patient access with patient scheduling from Experian Health.

Imagine if every time you wanted to sign up to buy groceries online, book a vacation, or apply for a job, you had to fill out a paper registration form. For 21st century consumers who are accustomed to sleek digital and self-service experiences in industries such as retail, travel and banking, such an antiquated and cumbersome process seems unthinkable. Unfortunately, when it comes to healthcare services, we don’t have to use our imagination. Too often, we’re still required to fill out time-consuming, repetitive and tedious forms before accessing services. For providers who want to stay competitive, the long waits and wasted time that arise from paper-based registration system do nothing to win consumer loyalty. And on top of the disappointing patient experience, manual intake processes often lead to delays and errors that can disrupt the billing cycle, costing time and money further down the line. In fact, up to half of denied claims occur because of issues around the point of registration, such as identification errors, sub-standard data analytics and inefficient workflows. And at a time when patients and staff are trying to minimize face-to-face contact due to COVID-19, manual registration seems like an unnecessary extra touch point. Is it time to say goodbye to paper-based paper registration? Reimagining the patient intake experience for the digital age During registration, patients can be asked to provide personal details, submit their medical history, and confirm payer information. They may also need to schedule appointments, organize billing, or sign up for care management programs. It’s often a patient’s first glimpse of how a provider is going to look after them, so making the registration experience as stress-free as possible is a great way to build customer loyalty from the start. As the competition for consumer business heats up, providers should look for ways to give patients the virtual and mobile-friendly experience they desire, with as little time as possible spent in waiting rooms filling in forms. By letting patients tick off their registration to-do list online or via a mobile device – before even coming into hospital – providers can improve patient satisfaction, while using automated workflows to drive down costly errors and increase revenue. Here are two examples of how healthcare providers have embraced self-service registration and automated pre-registration workflows to benefit both their consumers and bottom line: 1. Schneck Medical Center used automated pre-registration to double their productivity For the patient access team at Schneck Medical Center, getting the correct patient information in a timely manner during registration was a challenge. By introducing  eCare NEXT®, they were able to automate pre-registration workflows so the majority of manual, repetitive patient tasks could be completed automatically, freeing up staff to focus on patients who needed specific attention before being cleared. With Registration QA added to the mix, they could track and correct errors and spot opportunities to improve performance in real-time, for a better patient experience and more efficient operations. Skylar Earley, Director of Patient Access and Communication, said that by using Experian Health’s patient intake solutions, “we were able to make some fairly minor workflow changes, but double our pre-registration productivity on a daily basis and then repurpose some labor to different areas in patient access.” 2. Martin Luther King Jr. Community Hospital (MLKCH) used automated registration to reduce claim denials Seeing that a large portion of claim denials were originating during patient registration, MLKCH introduced an automated registration workflow to eliminate unnecessary manual tasks and increase the accuracy of the data being collected. For Patient Access Manager Lori Westman, the results have been impressive: “We get fewer denials because we’re getting true verification data, and our patient volumes continue to increase. So the fact that we can take off at least two to three minutes on half of our registrations is speeding up the work for the team, and the turnaround time is much better for the patients.” By reducing paper-based tasks and introducing automated pre-registration options, these providers were able to make life easier for patients while slimming down their workflows. Is it time for your organization to do the same? Download our free eBook to find out more about how automated patient intake workflows could help you create a seamless, more efficient patient registration experience.

Key takeaways: Revenue cycle teams can use automation to reduce repetitive work and apply AI where data-driven prediction, matching or prioritization can improve a workflow. Experian Health’s 2025 State of Claims survey found that 41% of providers now face denial rates of 10% or higher, while 68% say submitting clean claims is more challenging than a year ago. Patient Access Curator™ (PAC) uses AI to support front-end data validation and insurance discovery, while AI Advantage™ helps teams predict denial risk and prioritize denial follow-up. Artificial intelligence (AI) and automation can support administrative work in healthcare. In the revenue cycle, teams depend on accurate information, timely decisions and efficient follow-up to keep claims moving. In revenue cycle management, AI and automation can help organizations reduce manual checks, find data gaps, predict denial risk and prioritize work queues. These tools are most useful when they support staff judgment, payer expertise and compliance oversight. They can handle repetitive, data-heavy tasks so staff can focus on exceptions and decisions that need human review. In 2023, McKinsey & Company reported that research suggests effectively deploying automation and analytics could eliminate $200 billion to $360 billion of spending in U.S. healthcare. For revenue cycle leaders, the practical question is where to apply those capabilities first. The case for applying AI and automation in healthcare Revenue cycle teams juggle many daily tasks. Staff collect and verify patient information, confirm eligibility, identify the right payer, submit clean claims, monitor status, work denials and manage collections. Small data gaps at the beginning of the process can create downstream rework and delays. Rework also consumes staff time, adding to these operational pressures. As costs rise and revenue cycles tighten, there is increasing pressure to do more with less. Experian Health’s 2025 State of Claims survey found that 54% of providers say claim errors are increasing and 90% of claim denials are reworked with at least some human review before resubmission. Providers are also managing broader financial and administrative pressures. The American Hospital Association has reported that prior authorization requirements, claim audits, denials and other payer policies add administrative burden and cost for hospitals and health systems. These requirements also consume staff time to appeal denials and manage payer processes. AI and automation are different but complementary. Automation follows defined rules to complete repeatable work. AI models can identify patterns in data, predict risk and help teams decide where to focus attention. When used together, they can support more consistent revenue cycle workflows. How AI and automation can support revenue cycle workflows Revenue cycle management automation and AI are most useful when tied to a specific workflow and a measurable operational problem. The goal is to help teams act earlier, reduce avoidable rework and focus staff time where judgment is needed most. For example, automation can complete rule-based eligibility checks. AI can help identify claims with a higher likelihood of denial. In insurance discovery workflows, AI can also help identify coverage that wasn’t captured at registration. When these tools fit into existing workflows, they can support more consistent decisions and reduce manual work. Three practical applications include: 1. Improving front-end data quality with Patient Access Curator Patient and coverage information collected early in the revenue cycle can affect downstream claim outcomes. Incomplete or outdated demographic details, eligibility responses, coordination of benefits or Medicare Beneficiary Identifier information can create problems that lead to claim delays or denials later in the cycle. Experian Health’s Patient Access Curator helps prevent claim denials by validating demographics, eligibility, insurance discovery, coordination of benefits and Medicare Beneficiary Identifier data in seconds. PAC’s AI and machine learning capabilities help improve match accuracy, coverage sequencing and data confidence by writing the validated data back into the host system and sequencing payers before the claim is created. This automates work that would otherwise require manual coverage checks. 2. Using insurance discovery to find coverage not captured at registration When active coverage isn’t identified during registration, claims may be delayed or submitted with incomplete insurance information. Insurance discovery looks for coverage that may not have been captured during registration. Patient Access Curator includes insurance discovery as part of its front-end validation workflow. It can help identify and correct missing or incorrect insurance information so claims can be submitted with more complete coverage data. 3. Using AI to prevent and prioritize denials Even with strong front-end processes, some claims still require additional attention. AI can help claims teams decide which claims to review before submission and which denials to work first after payer response. Experian Health’s AI Advantage supports two denial management use cases:1. AI Advantage – Predictive Denials uses a client’s historical claims data and Experian’s knowledge of payer rules to identify claims with a high likelihood of denial before submission so teams can take corrective action.2. AI Advantage – Denial Triage uses AI to segment denials and identify those with the highest potential for reimbursement. This approach can help teams prioritize with more confidence. Rather than treating every claim or denial the same way, teams can use predictive models to focus on the work that needs the most attention. Potential benefits of AI and automation in the revenue cycle A high-performing revenue cycle depends on timely, accurate and consistent work. AI and automation can help providers modernize that work without losing the expertise of the people who manage complex payer and patient situations every day. When applied to the right workflows, these tools can help organizations: Reduce manual data searches that take staff away from higher-value work Improve front-end data quality before claims are created Identify missing or incorrect coverage information earlier Spot claims that may be at higher risk of denial Prioritize denied claims by potential reimbursement Reduce rework caused by inaccurate or incomplete information Give staff more consistent information for follow-up decisions A focused AI strategy starts with the workflow problem, uses data that is relevant to that problem and keeps staff in control of judgment-based decisions. A more proactive approach to revenue cycle management Revenue cycle teams can move from reactive work toward a more proactive approach: catch errors earlier, validate coverage before claims are created and prioritize the claims and denials that need the most attention. Experian Health offers revenue cycle solutions that use AI and automation in targeted ways to support front-end data quality, reduce rework and manage denials. Patient Access Curator supports registration and coverage validation, while AI Advantage supports denial prediction and triage. Learn more about Experian Health’s Patient Access Curator and AI Advantage.

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

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