Denied claims and AI, with Clarissa Riggins of Experian Health

Denied claims are cutting deeper into practice revenue — and the numbers are getting worse.

In this episode, Medical Economics Managing Editor Todd Shryock talks with Clarissa Riggins, chief product officer at Experian Health, about the company’s 2025 State of Claims Report.

Riggins explains why claim denials are rising, how inaccurate patient data and staffing shortages are fueling the problem, and where artificial intelligence (AI) can make a measurable difference. She also discusses how practices can use automation and predictive analytics to prevent denials before they happen, and why getting ahead of payer complexity is now essential to financial survival.

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Music Credits:
Ambient Jazz by AurbanniAudio - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – Cold open
“If you can address the issues from the outset of the revenue cycle, it makes everything so much easier — and helps prevent denials before they happen.”

0:20 – Introduction
Austin Littrell introduces Off the Chart and previews the conversation between Todd Shryock and Clarissa Riggins, Chief Product Officer at Experian Health.

1:22 – Setting the stage
Todd introduces the 2025 State of Claims Report and asks what’s driving the sharp rise in claim denials.

1:59 – The top cause: bad data
Riggins explains how missing or inaccurate patient data has become the leading driver of denials — and why AI could help fix it.

2:32 – Why clean claims are harder to submit
Riggins discusses new regulatory pressures, workflow friction, and the challenges of preparing for complex documentation requirements.

4:01 – Staffing shortages and technology gaps
How workforce turnover and fragmented tech stacks compound denial problems and strain practice operations.

5:34 – The biggest problem areas
Why fixing inaccurate data and registration errors at intake remains the most urgent step for revenue recovery.

6:32 – The AI awareness gap
Although 62% of providers say they understand AI, only 14% use it. Riggins explains the hesitation — and how to start small.

7:59 – Lessons from early adopters
Practices seeing ROI from AI share common traits: they start small, track measurable outcomes, and scale success.

9:01 – Building trust in AI
Riggins discusses HIPAA, payer rules, and why transparency is key to physician confidence in AI-driven claims tools.

12:01 – Falling confidence in tech
Todd asks why fewer providers feel their claims systems are effective — and what’s behind the frustration.

12:56 – Fixing payer–provider collaboration
Why better technology and open communication are both needed to reduce denials for good.

13:59 – Where providers should start with AI
Practical first steps for adopting automation — from identifying pain points to choosing the right technology partners.

16:36 – Training and workflow integration
How to implement new AI tools with minimal disruption and staff retraining.

18:28 – What surprised Experian most
Riggins shares the biggest takeaways from the State of Claims data — and why adoption still lags optimism.

19:30 – Final takeaways
Why AI works best when it starts small, delivers measurable ROI, and helps staff focus on higher-value work.

22:12 – Closing
Todd thanks Clarissa for joining, followed by Austin’s closing credits and subscription reminder.