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Welcome Katie Zibelin, Experian Health Marketing’s newest team member. Katie made her Experian debut in August 2015 as an intern where she supported client events, tradeshows and proposal efforts behind the scenes.  Upon securing her advertising degree from the University of Texas at Austin in December 2015–one semester ahead of schedule–Katie joined the team full time this February. In her current role as a Marketing Coordinator, Katie is responsible for tracking projects, managing vendor activities, conducting tradeshow and vendor research, developing new vendor relationships, coordinating and supervising tradeshow activities and communicating programs and events. Katie also serves as the project leader of our 2016 Regional User Conferences. In her first solo performance at our Southeast Regional Conference in New Orleans, Katie received rave reviews for demonstrating project management and event planning maturity and grace under pressure. Fun Fact: Katie is also an accomplished contemporary dancer/performer/instructor. Please do not hesitate to reach out to Katie with questions regarding any of the upcoming Regional User Conferences at Katie.Zibelin@experianhealth.com.

Did you know? In 2015, Experian Health helped nearly 700 provider clients screen over 51 million patients for financial assistance. That’s important for healthcare providers that are ramping up to meet 501r regulation requirements this year. Experian Health’s Patient Financial Clearance automates the financial screening process prior to service or at the point of service, to determine if patients qualify for Medicaid, charity or any assistance program, while auto-enrolling eligible patients. This new solution can help you: Meet 501r regulatory requirements Increase staff productivity by expediting financial assistance decisions Improve point-of-service collections Reduce overall AR days Patient Financial Clearance uses a proven combination of consumer data, patient-provided information and provider policies to automate the screening process and empower patient access staff to be more productive and effective. Help your patients while protecting your bottom line. Contact us today at experianhealth@experian.com or 1 888 661 5657 to find out how Patient Financial Clearance can help you.

Screening for the Human Immunodeficiency Virus (HIV) infection On February 5, CMS released a change request to inform contractors that CMS has determined that the evidence is adequate to conclude that screening of HIV infection for all individuals between the ages of 15-65 years is reasonable and necessary for early detection of HIV and is appropriate for individuals entitled to benefits under Part A or enrolled in Part B. Effective date: April 13, 2015 Implementation date: March 7, 2016, for non-shared A/B MAC edits; July 5, 2016 for CWF analysis and design; October 3, 2016, for CWF Coding, Testing and Implementation, MCS, and FISS Implementation; January 3, 2017, for Requirement 9403.04.9 View Transmittal R3461CP View Transmittal R190NCD Screening for Cervical Cancer with Human Papillomavirus (HPV) testing On February 5, CMS released a change request stating CMS has determined that for dates of service on or after July 9, 2015, evidence is sufficient to add HPV testing under specified conditions. Effective date: July 9, 2015 Implementation date: March 7, 2016, for non-shared MAC edits; July 5, 2016, for CWF analysis and design; October 3, 2016, for CWF Coding, Testing and Implementation, MCS, and FISS Implementation; January 3, 2017, for Requirement BR9434.04.8.2 View Transmittal R3460CP View Transmittal R189NCD Revision to Fiscal Intermediary Shared System (FISS) lab travel allowance editing to include new specimen collection code G0471 On February 5, CMS released a change request updating FISS reason code 32436 to include HCPCS code G0471 in the list of specimen collection fee codes that will allow the travel allowance to be paid on outpatient claims. Effective date: April 1, 2016 Implementation date: July 5, 2016, for claims processed on or after View Transmittal R1619OTN View MLN Matters article MM9471

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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