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by Krishna Nelluri 3 min read October 22, 2026

At A Glance

Revenue cycle management automation and artificial intelligence (AI) can help healthcare organizations reduce manual work, catch errors earlier and prioritize claims that need attention. Learn how revenue cycle teams can use AI-powered tools like Patient Access Curator and AI Advantage to support more efficient workflows.

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Healthcare organizations face ongoing pressure to identify every available source of insurance coverage and secure reimbursement for care already delivered. Coverage can change, become active or become discoverable after a patient receives care, creating the risk that eligible claims go unpaid. Providers need a stronger way to uncover missed coverage and protect revenue after the point of service.

Experian Health is helping address this challenge through its acquisition of eInsights, which serves more than 200 U.S. healthcare organizations and has helped clients recover more than $225 million in reimbursements. By expanding Experian Health’s insurance discovery capabilities beyond the front end of the revenue cycle, the acquisition helps healthcare organizations identify coverage that may otherwise be missed and recover reimbursements tied to care already delivered.

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Finding insurance coverage shouldn’t be a one-time event. A patient’s coverage can change or become discoverable after care is delivered, and when that happens, providers can miss reimbursement and patients can end up with bills they shouldn’t have received.

Experian North AmericaJason Considine, President of Experian Health
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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’s2025 State of Claims surveyfound 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, whileAI Advantage™helps teams predict denial risk and prioritize denial follow-up.

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Phillip Scott of NCPDP attended HIMSS17 and took some time to chat with IntrepidNOW about NCPDP’s strategic alliance with Experian Health and the benefits of a universal patient identifier. Below is an excerpt from that interview. “Well, I have to say with NCPDP’s reputation of neutrality is it’s been a key to our business, our business model. We bring all parties to the table. It’s big in collaboration and all of our standards and best practices come from a consensus building environment. Well, having said that, we have been looking for some time at a relationship that could create a unique patient identifier, at least our version of what that would be. We vetted a number of different companies and actually started working on this in 2013. The good fortune brought us in touch with Experian [Health], and we come together nicely, culturally. We both spent a tremendous amount of effort working for the common good, and the solution that Experian [Health] brought to our vision for what a unique identifier was made for a great opportunity there, and we’ve been very excited about that offering. That UPI, that universal patient identity, would go to that number and when they marry my prescription or my pharmacy benefits to my medical benefits. Then it can move over and move out of pharmacy and over into the health systems. So not only is it great service, it’s just fun to think about it. So our effort gives you 2 versions of a flavor, we as an American consumers are all about instant gratification, right? So this gives you instant gratification because Experian [Health]’s identifying the numbers and identifying those patients uniquely, and sending it back to you, that is an instant gratification.” Listen to the full podcast Learn more about Experian Health’s Universal Identity Manager solution

April 28, 2017 by Experian Health

During HIMSS17, Experian Health’s Nicole Rogas, Senior Vice President of Sales, sat down with IntrepidNOW to discuss the healthcare industry, challenges providers are facing and women in health IT. Excerpt below. “…it’s an industry that changes consistently, and Experian Health has the data and the history to be able to arm both our clients, which our providers, and the consumer, which is the patient, with information to help them make better healthcare decisions. We are hearing more about it in IT and as well as other areas of healthcare really nationally. Women do play a very important role in the future of healthcare, and I think the focus on it now brings to light some of the sort of special issues and challenges we face as women that are very different than what man may face as they grow their career. …a lot of the challenges for our providers is to understand how to function as a business, and I know that that might sound crazy, but healthcare is always been a service, and most of our economies today, most of our people today believe that it’s really their right to (have) healthcare, and I think what’s happening is our healthcare providers are having to function more like a business organization to ensure that they are providing care at really great quality care, but in an efficient way. They are able to build and get reimbursed for that care, and then that they are able to arm their patients with the right information pre and post care to help keep them engaged in both their financial and their clinical journey. So I just think it’s a big time in our industry.” Listen to the full podcast

April 26, 2017 by Experian Health

Last week, Experian Health announced the launch of Patient Schedule, an innovative new solution that allows for real-time integration across organizations to streamline active patient self-service appointment scheduling, powered by MyHealthDirect. During HIMSS17, Jason Kressel, SVP Product and Account Management of MyHealthDirect, sat down with IntrepidNOW for a discussion about online patient scheduling. Excerpt below: “I think healthcare organizations are recognizing that in order to be competitive that they have to offer services that patients are demanding. And so while offering online scheduling for patients is a different way for patients to access healthcare providers requiring a little bit of a change to the provider workflow, ultimately they’re seeing the value of doing that because patients are more adherent to the services that they are supposed to be obtaining, and they’re happier when they come into the physician’s office. So there’s definitely work that’s done with the healthcare organizations to explain the changes in workflow, and what it means to make online scheduling accessible for their communities. But at the end of the day I think they all recognize the value of offering those types of services and are slowly shifting to full adoption. …So one of the things that we will be working on is, from that Experian patient portal once they have a patient engaged through that channel, allowing the patient to search for a provider and book an appointment directly from the Experian patient portal. Another example, Experian Health does a lot of work around order management, if a hospital creates an order for a service that should take place in an ambulatory setting, right now they can manage the order but they can’t schedule the appointment for that, so we’ll also be incorporating the ability to schedule directly from the Experian Health platform.” Listen to the full podcast Read our press release, “Experian Health and MyHealthDirect team up to improve practice workflow with cloud-based patient scheduling across healthcare networks” Learn more about Patient Schedule  

April 24, 2017 by Experian Health

Earlier this year, Experian Health joined forces with hc1.com to empower companies to recapture lost revenue, control costs and better serve patients. At HIMSS17, Brad Bostic, CEO of HC1 sat down with IntrepidNOW’s Joe Lavelle to discuss this and healthcare industry trends. Excerpt below: “…our customers has really span medical laboratories, health systems and post-acute care providers. And the common challenge that these organizations face is that they’re so intensely focused on their internal clinical quality and processes and how do you code for things to make sure that they can get billed, that it’s difficult for them to rise up to the level of truly seeing the full picture of what they’re doing with their customers, and understanding holistically where do I have areas that I need to focus to be able to perform better financially? …what we’ve done is we’ve really built this partnership to bring healthcare relationship management together with the best of Experian Health’s products in the eCare NEXT and payer alerts areas, and what eCare NEXT and payer alerts do in combination with our HIPAA compliant HC1 platform is that we’re able to bring this level of financial risk stratification to the picture, so that if I’m a lab I can see across all the different providers that are referring to me and all the different patients that are flowing through, where are the places where I might be exposed to where I might not get reimbursed? And it’s doing this on the front end of the process rather than having it be an unpleasant surprise later on in the process that you haven’t gotten paid.” Listen to the full podcast Explore our revenue cycle management solutions

April 19, 2017 by Experian Health

Jason Considine, Senior Vice President, Patient Collections & Engagement, with Experian Health, sat down with Joe Lavelle from IntrepidNOW at HIMSS17 to talk patient engagement. Excerpt: “I think hospitals have spent tons of money really customizing the clinical experience for the patient over the last really 10 years and if you go into any hospital large hospital in America today, you’re going to feel like your care has been customized for you. But when you exit the care delivery mechanism and you get into the billing process, I still see providers treating patients kind of in a one size fits all method, and that’s where I see a lot of patient engagement changing from a financial perspective is using the power of information like what Experian has. We know what a patient’s financial disposition is, whether they can pay their bill or not, whether they qualify for the hospital’s financial assistance mechanism or not, and we can be more proactive in building that relationship and sending them offers to pay their bill and customize those types of engagements more appropriately for that you unique patient’s needs. We are the Best in KLAS vendor for patient access solutions, the eCare NEXT products suite. We are very focused on taking those tools that have been adopted by providers across the United States and making them patient facing. And so we have portals that can be accessed from any mobile device and from a desktop or laptop, and give the patient the ability to shop for care using self-service estimates. Pay their bill online and set up new payment plans and really communicate with their providers in the mechanism in vehicles in which they want to do it.” Listen to the full podcast Learn about our Collections and Patient Engagement solutions.

April 10, 2017 by Experian Health

Experian Health was honored to host Frank Abagnale, one of the world’s foremost experts on identity theft, forgery, and embezzlement, during our #JointheConversation radio show at HIMSS17. You’ll know Frank from the great movie and book, Catch Me if You Can.  Frank has been a consultant to the FBI for over 41 years. He also developed a fraud detection technology called the 41st Parameter that Experian purchased in 2013 and it now operates in 80 countries around the world. Frank was honored to be selected by HIMSS this year to lead a presentation called “Stealing Your Life” where he focused on identity theft in healthcare and represented Experian Health to discuss this topic. His presentation focused on the significance of fraud in today’s healthcare world; illustrating the enormity of identity theft crimes and how they affect an individual’s life in many areas including health insurance, credit, income taxes including refunds, banking, just to name a few. Hear Frank’s assessment of healthcare’s susceptibility to breaches, the current state of cybersecurity, privacy and identity theft, as well as helpful strategies to personally avoid becoming a victim of identity theft. Listen to the complete podcast Learn about our Identity Management solutions

April 3, 2017 by Experian Health

The future for patient engagement becomes more clear every time we go out and do focus groups with providers and their patients. And what we are hearing from our clients and providers is that 40% of all their patients are on charity and 40% are on payment plans. So you are looking at about 80% of their patients needing charity or payment plans. And a lot of that is manual processes inside of the provider. And we also heard from a lot of consumers and patients that there is confusion about how they can afford their care. Clearly the thing that is on the top of our minds given this rising out of pocket expenses, is how can we anticipate what a patient needs when they leave the hospital using the Experian credit data? And then how can we proactively reach out to that patient with something that could be an activation offer for their charity care or their payment plan immediately after their service? We feel is this is a much more compassionate approach than what happens today. Leveraging the Experian credit data to be more proactive and predictive is a much more compassionate approach that will shift the patient’s behavior instead of the scenario where that patient takes their statement for $500 and put it under the stack of their bills. That one size fits all approach is not going to work anymore. We are moving to a very personalized patient engagement strategy that is more aligned with the patients’ needs and then give the patient all the digital automation tools so they can go and automate it and be done with it very quickly and they can focus on their health. Listen to the complete podcast Learn about our Patient Engagement solutions

March 24, 2017 by Experian Health

There has been a lot of uncertainty with regards to what the future holds for healthcare in the U.S., but the reality is that the move away from transaction-based services where providers are paid by transaction or by interaction with their patients, into a world where some of those services will be paid as bundles, is a reality. At Experian Health, our perspective is that there isn’t going to be one single form of payment. There isn’t going to be only fee for transaction or only fee for value type payments.  There is going to be a variety.  And our solutions can help providers handle that. When we talk to our largest providers, they want to make sure that they are prepared for the future of healthcare, and that their payment and revenue cycle is robust enough that they can handle whether it is a fee for transaction interaction with the provider or with the patient as well as fee for value. In order to do that, they have to optimize their operations. There is a lot of belt tightening happening in the industry and people are trying to see and understand how best to organize, how best to analyze and facilitate that payment cycle. We believe that data and analytics are two of the key ways to do that. Our software tools as well as the data that we embed into that software helps optimize the revenue cycle. Listen to the complete podcast

March 24, 2017 by Experian Health

Take Our Daughters and Sons to Work Day

March 14, 2017 by Experian Health

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COVID-19 provided an unexpected use case for patient portals. In a matter of weeks, the benefits of remote patient access were undeniable. Patient portals allowed patients to schedule, register and pay for care from the comfort and safety of home. Now, as the latest omicron sub-variant triggers another surge in case numbers, providers are again reminded of the value in making digital channels available to minimize face-to-face interaction. With staffing shortages continuing and patient numbers rising, it’s worth recapping the benefits of patient portals. Why should healthcare providers prioritize patient portals? Here are 7 reasons: 1. Patient portals can be used to communicate safely with patients as Covid-19 cases rise Health officials may be cautious about reinstating extreme measures in response to the latest wave of infections. However, they can’t afford to be complacent about an uptick in hospital admissions. Patient portals can mitigate the risks associated with increasing foot traffic by allowing patients to schedule and register for care without attending in person. Completing paperwork from home eliminates the need for patients to share clipboards or sit in stuffy waiting rooms, while online scheduling platforms enable staff to manage the flow of patients safely and efficiently. Remote patient monitoring, secure messaging and online prescription refill requests can also be managed via portals, further reducing the need for in-person visits. 2. They can ease pressure on understaffed teams Providers need to find efficient ways to handle the administrative workload that comes with higher patient volumes. It’s even tougher given increasing retirement and resignation figures. More nurses are embracing the occupational benefits of remote and virtual care and are opting to switch from high-stress facilities to telehealth positions. While this speaks to the growth and impact of remote healthcare, it leaves a gap to be filled in hospitals. Patient portals can alleviate some of the burdens by reducing the need for staff input at various points in the patient journey. For example, online scheduling reduces the number of calls to call centers. Pre-filled data and automated registration can reduce the risk of errors during patient intake, which are time-consuming to fix. Portals can also be used to help patients navigate the payments process, speeding up collections and reducing the time staff spend chasing payments. 3. Patient portals can address inefficient patient access workflows Because patient portals are tethered to the patient’s electronic health record (EHR), they provide a hub for every piece of data relating to the patient. Patients can access that golden record at any time. They get an engaging and transparent experience, and are less likely to call up to ask questions – they already have the answers. They can also check data to make sure that it’s accurate, which helps avoid the delays and misunderstandings that cause friction for patient access teams. It’s important to ensure that the portal itself doesn’t introduce friction. Patients need to be able to enroll in the portal without too much trouble. Automating the patient enrollment process and implementing a multi-layered identity-proofing solution can create a secure and efficient way for patients to get the most out of their portal, without compromising safety or efficiency. 4. To improve patient engagement and meet consumer expectations One of the biggest reasons to invest in patient portals is because patients say they want them. Research from Experian Health and PYMNTS found that 44.1% of patients have obtained test results through patient portals, while 18% used patient portals to fill out forms for their most recent healthcare visit. Overall, two-thirds said they use patient portals. Beyond offering a convenient patient experience, this is also a matter of patient loyalty and retention: 61% of patients say they’d consider switching providers to one that offered a patient portal, which could have a significant impact on revenue. 5. They can boost revenue by offering easy ways to pay Experian and PYMNTS research shows that around a fifth of patients uses their portal to make payments. Unfortunately, 16% of those patients said they’d faced difficulty viewing invoices, setting up payment plans and making payments through their portal, which suggests some room for improvement. Experian Health’s Patient Payment Solutions solves these challenges. A range of self-service, mobile-optimized tools simplify the patient financial journey by giving patients upfront pricing estimates, personalized payment plans and easy ways to pay. 6. Using patient portals can improve health outcomes (especially for “frequent flyers”) Patient portals also play an important role in promoting better health outcomes for patients. Research shows that when patients have access to their medical information, they feel empowered and prepared to speak to their doctor and adhere to care strategies. Multiple providers can engage with the patient through the same platform, and see what other treatments are being prescribed. This helps improve communication between the patient and provider and helps improve care management. It’s especially useful for older patients and those with chronic conditions. In this way, portals support effective care coordination, helping value-based care providers achieve their goals of reducing healthcare costs, promoting population health and closing the gaps in care that have widened over the last few years. 7. Patient portals can support compliance with price transparency regulations Finally, portals offer a route to ensuring compliance with new regulatory requirements around price transparency. The No Surprises Act and hospital price transparency rule call on providers to give patients accurate, upfront cost estimates so they can plan for their financial responsibility more easily. Patient Payment Estimates can be delivered in several ways, including through patient portals. And as noted, once the patient has their estimate, they can also be directed to easy and convenient payment methods, including through their portal. Whether it’s a surge in COVID-19 cases, rising inflation, or labor shortages, providers must find ways to build resilience, stay competitive, and continue to offer patients the flexible and transparent healthcare experience they desire. Patient portals should be part of the plan to open the digital front door. Contact us to find out how Experian Health helps healthcare organizations deliver a reliable and secure patient portal experience.

August 11, 2022 by Experian Health
Case study: Boost patient collections and scale patient scheduling with PatientDial

Discover how Dayton’s Children Hospital used PatientDial to boost collection rates and streamline patient communications.

July 6, 2022 by Experian Health
Deep diving into a successful healthcare revenue cycle flowchart

To ensure the patient’s financial journey goes ahead without a hitch, follow this 10-step healthcare revenue cycle flowchart.

June 22, 2022 by Experian Health
7 top healthcare revenue cycle challenges and how to overcome them

Healthcare revenue cycle challenges exist at every stage of the patient journey. Discover the top 7 and strategies to overcome them.

April 19, 2022 by Experian Health

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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.

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.

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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.

October 2, 2026 by Andy.Monte@experian.com
Experian Health ranked #1 in Best in KLAS for 2025

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