Utilizing artificial intelligence in claims management
By Kelly Nguyen | Published: 2025-09-08 10:00:00 | Source: Healthcare Blog
Main takeaways:
- Manual work and separate claims management systems are often prone to errors, leading to delayed and denied claims.
- Technology, such as automation and artificial intelligence, can help healthcare organizations predict and prevent potential claims problems before they are filed.
- Implementing AI-powered claims management solutions should be a top priority for revenue cycle leaders.
health care Denial of claims is on the rise But this is a new era of technology that can predict and prevent rejections before they happen. Leveraging AI in claims management can help organizations break the denial cycle and keep revenue cycles fluid.
In this article, we’ll explore how innovative solutions like Experian Health’s are Patient Access Secretary and Artificial Intelligence feature It is designed to help providers reduce claims denials using artificial intelligence.
Learn how Experian Health is reshaping the way health systems manage benefits coordination. Learn how automation and AI eliminate manual errors, reduce rejections and unlock millions in recoverable revenue.
Updating healthcare claims management tools
Claims management It is one of the most pressing challenges in health care billing. At Experian Health 2024 Claims status survey77% of providers said they were moderately to extremely concerned that payers would not reimburse them, largely due to changing payer policies and prior authorization requirements.
Revenue cycle leaders know this Good claims management It is the key to healthy cash flow and a strong financial foundation. However, with growing patient populations and more complex payer rules, traditional claims management solutions can no longer keep up. As a result, healthcare organizations today are feeling pressure to modernize their claims management processes and adopt solutions that rely on automation and AI-powered analytics to better predict, prevent, and address denials.
Predicting and preventing rejection using artificial intelligence
Healthcare providers can stop the spiral of denial before it starts by capturing accurate and complete patient data at registration. According to Experian Health data, 46% of exiles Resulting from missing or incorrect information. Now, many healthcare organizations are accelerating their digital transformations by implementing automation and AI tools designed to predict and prevent denials.
Automation creates consistent workflows, standardizes routine tasks, and reduces human error. Meanwhile, AI takes claims management to the next level by predicting denials, flagging claims errors before they are submitted and prioritizing claims that need attention. Leveraging AI solutions that form a closed-loop system can ensure clean data upon registration while predicting and preventing denials.
Front end solutions
Tools like Patient Access Secretary Automatically find and correct patient data within seconds – across eligibility, Coordination of Benefits (COB) priority, Medicare Beneficiary Identifiers (MBI), demographics, and insurance discovery. Machine learning and predictive analytics allow providers to identify bad data and correct it in real time, without the guesswork required.
Ken Copesti, Vice President of Revenue Cycle at Exact Sciences, shares how Patient Access Curator has improved eligibility processes, reduced errors, and more.
Back-end solutions
Experian Health Artificial intelligence feature It uses artificial intelligence and machine learning to predict and prevent denials. Artificial intelligence feature Not only does this predict claims outcomes mid-cycle, it pushes urgent tasks to the front of the queue – allowing staff to prioritize the most financially critical claims.
Expanded automation feature
to Reduce rejections and delays, Providers can look to implement automation and AI across the entire claims ecosystem. For example, Patient Access Curator and AI Advantage integrate seamlessly with solutions that manage the entire claims cycle, such as Experian Health Claim Source®– Use real-time insights generated by ClaimSource to detect patterns and predict future payer behavior.
In addition, tools such as Demand washing It can automate the claims filtering process – reducing potential errors, administrative burden, and the need for costly reworks. Organizations can also add Workflow Manager denies To automate and improve the denial management portion of the claims cycle, improve employee productivity and speed up the reimbursement process.
Artificial Intelligence for Claims Management – Frequently Asked Questions
Want to learn more about how Experian Health’s AI tools can help reduce and prevent claims denials? Consider these frequently asked questions.
Artificial intelligence feature It operates in two stages of claims management, with two offerings: Predictive denials and Deny sorting. In the first phase, predictive denials use artificial intelligence and machine learning to look for patterns in payer decisions and identify undocumented rules that may lead to new denials. This solution also flags claims with a high probability of denial, so the right specialist can intervene before claims go to payers. After a claim is denied, the Phase 2 component of AI Advantage uses advanced algorithms to identify denials and segment them based on their potential value.
Experian Health Patient Access Secretary It is a powerful patient intake and verification solution designed to eliminate errors that often lead to rejection, such as missing or incorrect information. Through artificial intelligence and robotic process automation, Patient Access Curator automatically scans and verifies patient demographic information, insurance details, eligibility, and more – reducing claims denial rates and administrative burden.
Patient Access SecretaryAnd Artificial intelligence feature Forming a closed-loop system provides healthcare organizations with a smarter, faster and more scalable approach Reduce denials Increase refunds while reducing the administrative burden on employees.
Bottom line: Providers can reduce claims denials using AI
Taking advantage of artificial intelligence in Claims management “This can improve the overall efficiency and accuracy of healthcare claims processing – resulting in fewer denials and a smoother patient experience. Instead of waiting for a denial to occur before taking remedial action, healthcare organizations can stay one step ahead with claims management solutions that use AI and automation. These tools can help proactively detect errors and diagnose pain points in the claims process for a healthier revenue cycle.”
As Jason Considine, president of Experian Health, recently said: “With the power of AI and predictive intelligence, we’re no longer waiting for denial to happen; we’re helping providers prevent them proactively.” Tools like Experian Health Patient Access Secretary and Artificial intelligence feature Allow healthcare organizations to identify issues at enrollment and throughout the revenue cycle, so teams can focus on care, not corrections. It’s about working smarter, reducing risk and protecting revenue
Find out more about how Experian Health works AI-powered claims management solutions Helping healthcare providers improve reimbursement rates and reduce denials.
(tags for translation) AI Feature
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