For affected person entry leaders at massive healthcare organizations, the strain is mounting and has been constructing for a while.
Healthcare declare denials are climbing. Staffing is stretched, and the instruments healthcare organizations have relied on for years are not sufficient. However what if suppliers may cease denials earlier than they begin?
Welcome to the brand new period of denial prevention in healthcare, powered by predictive intelligence. Experian Well being’s revolutionary synthetic intelligence (AI) options, Patient Access Curator and AI Advantage™, had been designed to assist organizations forestall denials earlier than they happen.
Discover how Experian Well being is reshaping the best way well being programs handle Coordination of Advantages. Find out how automation and AI are eliminating handbook errors, lowering denials and unlocking tens of millions in recoverable income.
The denial spiral defined: A systemic problem in income cycle administration
Declare denials aren’t only a back-end billing concern. They’re a symptom of upstream breakdowns—usually rooted in inaccurate or incomplete affected person knowledge at registration. In response to Experian Health’s 2024 State of Claims Survey, 46% of denials are attributable to lacking or incorrect info. And the price of remodeling a denied declare? $25 for providers and $181 for hospitals.
The consequence? A denial spiral that drains sources, delays reimbursements, and frustrates sufferers and employees alike.
Why Epic customers are particularly weak
Whereas Epic is a robust EHR platform, many Epic-based organizations nonetheless depend on employees to make complicated selections at registration.
Questions like:
- Is that this protection main?
- Ought to discovery be run?
- Is that this knowledge correct?
…are sometimes left to frontline employees. This guesswork results in inconsistent outcomes—and denials.
What’s wanted is a layer of predictive intelligence that works inside Epic to automate and proper knowledge earlier than it turns into an issue.
How Affected person Entry Curator fixes registration errors
Patient Access Curator is that layer.
Patient Access Curator is an all-in-one answer that robotically finds and corrects affected person knowledge throughout eligibility, Coordination of Advantages (COB) primacy, Medicare Beneficiary Identifiers (MBI), demographics and insurance coverage discovery—inside seconds. It integrates straight into Epic workflows, eliminating the necessity for employees to toggle between programs or make judgment calls on the fly.
As an alternative of counting on registrars to catch each error, Affected person Entry Curator makes use of machine studying and predictive analytics to:
– Determine and proper unhealthy knowledge in actual time
– Return complete protection straight into Epic
– Scale back denials, write-offs, and vendor charges
– Enhance employees morale by eradicating administrative burden
As one early-adopting Patient Access Curator shopper places it: “In case your present workflow nonetheless will depend on frontline selections, you’re not simply risking denials—you’re constructing them in.”
Predictive intelligence in healthcare: AI Benefit at work
Whereas Patient Access Curator fixes the entrance finish, AI Advantage tackles the center of the income cycle, the place claims are scrubbed, edited, and submitted.
At Schneck Medical Center, AI Advantage helped scale back denials by 4.6% per 30 days and reduce denial decision time by 4x. The software flags high-risk claims earlier than submission and routes them to the proper biller for correction. It additionally triages denials primarily based on the probability of reimbursement, so employees can deal with the claims that matter most.
Collectively, Patient Access Curator and AI Advantage kind a closed-loop system:
– Affected person Entry Curator ensures clear knowledge at registration
– AI Benefit predicts and prevents denials mid-cycle
– Each instruments combine seamlessly with Epic and ClaimSource®
Why predictive denial prevention issues for affected person entry leaders
By implementing denial administration know-how and predictive intelligence, healthcare groups aren’t simply managing workflows; they’re managing threat. Each inaccurate discipline, each missed protection, each handbook determination is a possible denial.
Patient Access Curator and AI Advantage take away that threat by changing guesswork with certainty.
And the advantages transcend income:
– Fewer denials imply fewer affected person callbacks and fewer frustration
– Cleaner knowledge means sooner reimbursements and fewer write-offs
– Automation means employees can deal with sufferers, not paperwork
As Jason Considine, President at Experian Well being, not too long ago shared: “Our mission is to simplify healthcare. That begins by getting it proper the primary time, earlier than a declare is ever submitted. With the ability of AI and predictive intelligence, we’re not ready for denials to occur;we’re serving to suppliers proactively forestall them. Instruments like Affected person Entry Curator and AI Benefit permit healthcare organizations to determine points on the level of registration and all through the income cycle, so groups can deal with care, not corrections. It’s about working smarter, lowering threat and defending income.“
Denial prevention guidelines: Making ready affected person entry groups for predictive denial prevention
Denial prevention is right here, however what if billing groups aren’t fairly prepared? To maneuver towards a predictive denial prevention technique, healthcare organizations can spend money on the next 5 areas:
- Audit front-end workflows
Map out each step from affected person registration to assert submission. Determine the place handbook selections are being made—particularly round eligibility, COB, and insurance coverage discovery. Ask: “The place are we counting on employees judgment as an alternative of system intelligence?” - Prepare employees on knowledge high quality consciousness
Reinforce the impression of inaccurate or incomplete knowledge on downstream denials. Use actual examples to point out how a single missed discipline can result in rework, write-offs, or affected person frustration. Introduce the idea of “first-touch accuracy” as a team-wide aim. - Consider Epic integration readiness
Assess whether or not present Epic environments are configured to assist automation instruments like Affected person Entry Curator. Work with IT to evaluate whether or not the present setup permits for real-time knowledge correction and protection updates. Affirm that groups perceive how new instruments will combine into their current workflows, not substitute them. - Set up a denial prevention activity power
Carry collectively leaders from affected person entry, billing, IT and income cycle to align on targets. Assign possession for key metrics like clear declare fee, denial fee, and registration accuracy. Use this group to pilot new instruments like Affected person Entry Curator and AI Benefit and collect suggestions from frontline customers. - Talk the “Why” behind the change
Body automation as a option to scale back burnout, not substitute jobs. Spotlight how instruments like Affected person Entry Curator remove guesswork and unlock employees to deal with affected person care. Share success tales from friends (like Schneck Medical Heart) to construct confidence and momentum.
The underside line: Strategic denial prevention is the long run
Denial administration is reactive. Denial prevention is strategic. For healthcare organizations utilizing Epic, Patient Access Curator and AI Advantage supply a wiser, sooner and extra scalable option to improve reimbursements and enhance the affected person expertise.
Study extra about how Experian Well being can assist shield income, scale back employees burdens and scale back declare denials—beginning on the first touchpoint.
