Healthcare claim denial statistics: State of Claims Report 2026

Key takeaways:

• As claim denials remain high, pressure is mounting on healthcare organizations to find new ways to reduce denials. In 2026, 89% of survey respondents say reducing denials is a priority.
• Artificial intelligence (AI) and automation-based tools, like Experian Health’s AI Advantage™ and Patient Access Curator™ (PAC), can help providers prevent avoidable denials and improve claims workflows.
• Most survey respondents say they’d replace existing claims management platforms if presented with compelling ROI: 83% say they would fully replace existing technology.

Claim denials are a well-documented challenge for healthcare organizations. Denied claims take much longer to pay out than first-time claims, if they get paid at all. Each one means additional hours of rework and follow-up, pulling in extra resources as staff review payer policies and figure out what went wrong. It’s time-consuming and costly. Beyond dollars and paperwork, denials affect patient care as uncertainty about payments leads to delays in treatment or unexpected out-of-pocket costs.

But how do healthcare leaders feel about the state of claims management today? How are they tackling the administrative burden? Is there any light at the end of the denials tunnel? Experian Health surveyed 204 healthcare staff responsible for finance, billing, registration, reimbursements, claims and collections to find out.

The 2026 State of Claims report breaks down the survey findings, including insights into how automation and AI technology are being used (or not!) to optimize the claims process for denial prevention and improve reimbursement.

What is the current denial rate for healthcare claims?

Health claims are still stuck in a cycle of denials, delays and data errors. 40% of survey respondents say that at least one in ten claims is denied. That’s a lot of rework and lost revenue that providers were counting on.

Payer friction is adding to the challenge. 79% of respondents say payer reimbursement is more challenging, 78% say payer policy changes are more frequent and 64% say time to reimbursement is increasing.

Today, 75% of providers agree that claim denials are increasing. And with this increase, providers constantly worry about who will pay — and when.

What are the most common reasons for healthcare claim denials?

According to the State of Claim survey respondents, the top reason for denials is services not covered, selected by 53% as one of their top three reasons. Frequently changing payer policies ranks second at 31%, while code inaccuracy errors and difficulty obtaining prior authorization are tied at 25%.

Inaccurate data still contributes to denials, but the front end is improving. In 2026, 43% of providers say between 5% and 15% or more of denials result from inaccurate data collected at patient registration and intake, down from 52% in 2025. Given how much information has to be processed and organized to fill out a single claim, reducing errors at intake remains important.

Other challenges, such as coding errors, uncovered services, eligibility checks and staff shortages still play a role, but the 2026 results make it clear that providers must address both internal data accuracy and changing payer requirements.

Could automation improve claim denial statistics?

To help break the denial spiral, more healthcare providers are turning to claims management software. Using technology helps organizations resolve or prevent the snags that interfere with claims processing and billing workflows and can boost claim success rates. That said, 35% of survey respondents cite dominant manual processes as a reason to evaluate their existing technology.

Yet, despite the benefits of integrated workflows and automation, the drive to implement new technology remains uneven.

In 2026, 48% of survey respondents say they upgraded or replaced their claims management technology in the last year. Another 40% automated or expanded portal claim reviews, while 37% automated payer-policy tracking.

While some tasks still genuinely require a human touch, staff time is often wasted on repetitive, process-driven activities that would be better handled through automation.

Here are a few ways claims automation can help improve claim denial statistics:

• Connect the entire claims process end-to-end: Using an automated, scalable claims management system – like ClaimSource® – helps providers manage the entire claims cycle in a single application. From importing claims files for faster processing to automatically formatting and submitting claims to payers, it simplifies the claims editing and submission process to boost productivity.
• Submit more accurate claims: 65% of survey respondents say submitting clean claims is more challenging than a year ago. There’s a strong case, then, for using an automated claim scrubbing tool to reduce errors. Claim Scrubber reviews pre-billed claims line by line so errors can be caught and corrected before being submitted to the payer, resulting in fewer avoidable errors and better use of staff time.
• Improve cash flow: Automating claim status monitoring is one way to accelerate claims processing and time to payment. Enhanced Claim Status eliminates manual follow-up so staff can process pended, returned-to-provider, denied or zero-pay transactions as quickly as possible.
• Reduce denials: Denials Workflow Manager automates the denial process to reduce manual reviews. It helps staff identify denied claims that can be resubmitted and tracks the root causes of denials to identify trends and improve performance. It also integrates with ClaimSource, Enhanced Claim Status and Contract Manager, so staff can view claim and denial information on a single screen.

Improving claim denial statistics with AI

While automation speeds up the denials workflow by taking care of data entry, AI can examine that data and recommend next steps.

In 2026, 9% of survey respondents say their organization is currently using AI, down from 14% in 2025. Adoption is still low, but interest is stronger: 64% say they definitely or probably plan to invest in AI for claims and denial management.

Current ClaimSource users can level up their claims management system by adding AI Advantage to their claims management workflow. AI Advantage uses predictive modeling to flag high-risk claims before submission and prioritize denials based on likelihood of reimbursement. The two components, Predictive Denials and Denial Triage, can help providers respond to the growing challenge of denials.

Other AI solutions like Patient Access Curator can also help organizations improve claims accuracy from the start. Patient Access Curator uses automation and AI to verify and correct eligibility, coordination of benefits primacy, demographics, Medicare Beneficiary Identifiers and insurance discovery information at patient intake.

Can AI break the claims denial spiral?

Technology is critical to improving claims management processes, but providers are still deciding how quickly AI can change the claims process. In 2026, 38% of survey respondents say AI can dramatically change claims and another 38% say yes, but it will take a while.

However, as claim denials continue to rise, organizations that adopt technology-based solutions that use automation and AI can work to prevent more avoidable denials and focus staff effort on the claims most likely to need attention.

Frequently asked questions

Download Experian Health’s 2026 State of Claims report for an inside look at the latest claim denial statistics and industry perspectives on claims and denials management.