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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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Did you know that it costs an average of $25 to rework a single claim?  It’s true, according to a recent Health IT News article. The article goes on further to state that as many as 65 percent of denied claims remain unresolved because they are too costly to rectify. These unpaid claims eventually become lost revenue. Experian Health’s Denials Workflow Manager and Enhanced Claim Status solutions are part of an integrated revenue cycle platform for healthcare providers to manage payer billing and payment processes.  Effective management of these processes directly results in improved cash flow, lower days in A/R, and more efficient operations. Clients converting to our integrated claims and denial solution are experiencing a 50% increase in clean claim rates and faster turnaround on cash. Learn more by visiting our Claims Management page or reserve your spot at one or both of our Claims sessions at the upcoming HFMA ANI conference: June 27 | 1:30pm | Manage Denials to Maximize Reimbursement, Revenue and Cash Flow June 28 | 9:45am | Claims Management

May 31, 2016 by Experian Health

Experian Health has launched Coverage Discovery® on demand, which is integrated into Epic’s EMR. We are the first-to-market with this functionality for Epic. In addition to Coverage Discovery’s batch reclassification of uncompensated care by finding previously misidentified patient coverage across both government and commercial payers by using advanced analytics, multiple data sources and a proprietary coverage optimization engine, the “on demand” feature provides Epic clients with additional opportunities to find coverage early in the revenue cycle—reducing additional downstream processes. By adding the on demand option, Experian Health’s clients can now run Coverage Discovery within their Epic workflow, which will help to reduce errors, save time and ultimately improve their revenue cycle. Every dollar found in our proactive, automated Coverage Discovery solution is a dollar that our clients are not spending pursuing patients for payment, paying for expensive collection agencies, or writing off to bad debt. Coverage Discovery is also available via eCare NEXT®, OneSource and Batch for non-Epic users. Coverage Discovery is providing significant results for over 300 Experian Health clients. In 2015, the solution discovered coverage associated with over $1.1 billion in charges. According to Murry Ford, Director, Revenue Strategy at Grady Health System, “Coverage Discovery consistently delivers value to our organization. Since our June 2015 go-live of the batch product and November 2015 go-live of the on demand product, Coverage Discovery has protected $2.3 million in reimbursement, $509,000 of which resulted from Coverage Discovery on demand queries for inpatient admissions over a two month period.” Read our latest press release, which further highlights Grady’s success using this solution.

May 31, 2016 by Experian Health

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.

May 25, 2016 by Experian Health

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.

May 24, 2016 by Experian Health

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

April 19, 2016 by Experian Health

After five years of ICD-10 classification system code freezes, October 1, 2016 will see the system back on the routine cycle for annual updates. On March 9th and 10th, the ICD-10 Coordination and Maintenance committee met to review proposals for both ICD-10-CM and ICD-10-PCS. All PCS codes to date that have been approved as new, revised, and deleted have been compiled into a file for review under the Coordination and Maintenance Committee meeting materials. For the October 1, 2016 update, there are currently 75,625 PCS codes for the FY 2017 update, which includes 3,651 new codes and 487 revised code titles. Of the 3,651 new codes, 3,549 are cardiovascular system codes. These relate to unique device values, the addition of bifurcation as a qualifier, and additional specific body parts, as well as congenital cardiac procedures and placement of an intravascular neurostimulator. All of the revised code titles at this time have come from changing the number of coronary artery sites to the number of vessels, and the specification of the descending thoracic aorta. Additional new codes include the expansion of the body part detail in Removal and Revision of lower joints, and the addition of unicondylar knee replacement. The codes presented at this meeting were for implementation in October 2016 and will be added to the already-approved list There were 24 diagnosis proposals on the agenda for discussion such as: Clostridium Difficile: A proposal was presented to expand the code to differentiate recurrent C. difficile  enterocolitis from enterocolitis not specified as recurrent. Congenital sacral dimple: The American Academy of Pediatrics proposed a new congenital code so this condition can be accurately tracked. Myocardial infarction: Specify the types as defined by several professional cardiology organizations. A specific code was proposed for type 2 myocardial infarction due to demand ischemia or ischemic imbalance so that data can be captured. The additional myocardial infarction types (3, 4a, 4b, 4c, 5) would all be assigned to one ICD-10-CM code. There was much discussion on this proposal related to the code proposals as well as the indexing and impact on subsequent myocardial infarctions. This proposal was requested for inclusion in the 10/1/16 addenda. Zika virus was discussed, regarding a new code being created. NCHS/CDC is proposing it for inclusion in the 10/1/16 addenda which would be consistent with the World Health Organization’s ICD-10 update According to CMS, the coding update will be implemented on Oct. 1, 2016, and will include the “backlog of all proposals for changes to the code set proposed via the ICD-10 Coordination and Maintenance Committee process during the partial code freeze, and receiving public support.” The codes are posted on the Centers for Disease Control and Prevention National Center for Health Statistics website here: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2017/NewICD10CMCodes_FY2017.txt Review the Meeting Agenda here: http://www.cdc.gov/nchs/data/icd/topic_packet_03_09_16.pdf

April 19, 2016 by Experian Health

On February 26th, CMS published a One-Time Notification, Transmittal 1630, Change Request 9540. This change request (CR) is the 6th maintenance update of ICD-10 conversions and other coding updates specific to national coverage determinations (NCDs) with   implementation date of July 5, 2016 for all Medicare Contractors The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD CR7818, CR8109, CR8197, CR8691, CR9087, and CR9252. Some are the result of revisions required to other NCD-related CRs released separately. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent, quarterly releases as needed. No policy-related changes are included with these updates as any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process The NCD’s updated per this CR are listed below: NCD20.29 – Hyperbaric Oxygen Therapy NCD90.1 – Pharmacogenomic Testing for Warfarin Response NCD110.18 – Aprepitant for Chemotherapy-Induced Emesis NCD150.3 – Bone Mineral Density Studies (See also Medlearn Matters SE 1525 04/12/16) NCD160.18 – Vagus Nerve Stimulation for Treatment of Seizures NCD160.24 – Deep Brain Stimulation for Essential Tremor NCD210.3 – Colorectal Cancer Screening Tests NCD210.14 – Screening for Lung Cancer with Low-Dose CT NCD230.18 – Sacral Nerve Stimulation for Urinary Incontinence NCD260.1 – Adult Liver Transplantation NCD110.4 – Extracorporeal Photopheresis NCD20.33 – Transcatheter Mitral Valve Repair NCD220.13 – Percutaneous Image-Guided Breast Biopsy NCD220.4 – Mammograms Read the details of this direction here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2016-Transmittals-Items/R1630OTN.html?DLPage=1&DLEntries=10&DLFilter=R1630Otn&DLSort=1&DLSortDir=ascending  

April 19, 2016 by Experian Health

At HHS, we’re working today with an eye on the horizon. We’re committed to building a health care system that provides better care, spends our health care dollars in smarter ways, and puts patients at the center of their care. Our aim is to strengthen health care so that it works for the health of every American. Our vision for this health care system is one where a patient can easily check their own medical record, where a patient’s different clinicians, from pharmacists to nurses to physicians, can more seamlessly work together to keep that patient healthy, and where treatment can easily be tailored to a specific patient’s needs. The key to unlocking that vision of a modern health care system is joining the data revolution that has already transformed so much of our society. Just recently, Secretary Burwell spoke at the 2016 conference of the Healthcare Information and Management Systems Society. She spoke about our need to unlock data to bring health care into the 21st century and how the security of patient data is essential to our progress. As she told the audience, “People should be able to easily and securely access their electronic health information and send it to any desired location. They need to be able to understand how their information can be shared and used. And they must be assured that this information will be effectively and safely used to benefit their health and that of their community.” Today, we’re taking a significant step to improve the safety of the data and security of life-saving medical devices across our health care system by announcing the membership of the Health Care Industry Cybersecurity Task Force. The members of this Task Force are leaders in government and private industry. They’re innovators in technology and pioneers in health care. They represent organizations of various sizes, and they hail from different parts of the country. Over the next year, these individuals will collectively look across industries and sectors to find the best ways organizations of all types are keeping data and connected medical devices safe and secure. They’ll discuss these ideas among themselves and, in the next year, they’ll report their findings to Congress and the public. They’ll also develop materials to share widely, ensuring every organization that plays a part in our health care system can protect the data that that is part of this system. As President Obama has made clear, cybersecurity is one of the most serious security challenges that our nation faces. So as we look to transform our health care system into one that works better for all Americans, we need to ensure it works safely for all Americans. We need to protect the data at the foundation of our health care system. That’s our commitment here at HHS, and it’s why we’re so excited to launch the Health Care Industry Cybersecurity Task Force.

April 19, 2016 by Experian Health

On March 16, CMS released three special edition MLN Matters articles on submitting claims to MACs for chiropractic services provided to Medicare beneficiaries. Special edition MLN Matters article SE 1601 helps clarify the CMS policy regarding Medicare coverage of chiropractic services and documentation requirements for the beneficiary’s initial visit and subsequent visits to the chiropractor. Special edition MLN Matters article SE 1602 explains the Active Treatment modifier (AT), which was developed to clearly define the difference between active treatment and maintenance treatment. Special edition MLN Matters article SE1603 provides a detailed list of informational/educational resources that can help chiropractors avoid billing errors due to insufficient or inaccurate documentation. Read More: MLN Matters article SE 1601: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1601.pdf MLN Matters article SE 1602: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1602.pdf MLN Matters article SE1603: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1603.pdf

April 19, 2016 by Experian Health

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Learn more about health insurance eligibility verification software and how it accelerates eligibility verifications, reduces denials and and much more.

February 2, 2023 by Experian Health
How to verify insurance eligibility for patients post-COVID-19

Learn how to proactively verify insurance eligibility to maintain cash flow and help patients navigate as the COVID-19 public health emergency ends.

November 23, 2022 by Experian Health
New alerts to address Appropriate Use Criteria and prior authorizations

With the Appropriate Use Criteria program slated to go into effect in 2023, healthcare providers shoud implement new alerts for prior authorizations.

October 24, 2022 by Experian Health
7 reasons to invest in patient portals

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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Andy’s New WP Workflow Test Article Using Quick Edit

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

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

February 5, 2025 by kelly.nguyen
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