Three-quarters of providers report rising denials, while most plan to invest in AI and automation to strengthen claims management

Key Highlights:

• 89% of providers say reducing denials is a priority for their organization in 2026, the highest level recorded since the survey began.
• Payer policy changes and reimbursement complexity are making claims management increasingly difficult.
• Providers see AI as a path forward, with 84% believing AI can improve claims management in some capacity.

COSTA MESA, Calif.: Healthcare providers continue to face significant reimbursement challenges as denials remain stubbornly high and payer requirements become increasingly difficult to navigate, according to Experian Health's 2026 State of Claims survey. Three-quarters (75%) of providers surveyed report that claim denials are increasing, while 40% say denial rates exceed 10% of claims, a figure that has remained largely unchanged from last year.

At the same time, nearly four in five providers surveyed (79%) report that securing reimbursement has become more difficult, while 78% say payer policies are changing more frequently, a notable increase from 67% in Experian Health’s first State of Claims survey in 2022.

"Providers recognize that denials are a growing threat, but their response isn't keeping pace with the problem," said Mindy Fortson, Chief Operating Officer at Experian Health. "Concerns about cost, return on investment and the rapid evolution of AI may explain some of the hesitation. But waiting has a cost, too. Every denial means more staff time spent reworking claims, longer reimbursement cycles and revenue that may never be recovered. Accurate data and the right technology can help identify problems upstream, reduce manual intervention and give revenue cycle teams a better opportunity to prevent avoidable denials before claims are submitted."

Denials Continue to Strain Revenue Cycle Performance

The survey findings show that challenges are mounting across the claims lifecycle, from claim creation to reimbursement:

• More than two-thirds (68%) of respondents report denial rates are higher than a year ago.
• 65% say submitting clean claims has become more difficult over the past 12 months.
• 64% indicate reimbursement timelines are growing longer.

When asked about the primary drivers of denials, providers most frequently cite services not covered by insurance. Missing coverage information, coding errors, evolving payer policies and prior authorization issues also ranked among the leading causes.

Providers See AI as Part of the Solution

Faced with mounting denial pressures, healthcare organizations are increasingly evaluating new technologies to improve claims performance and reduce administrative burden, such as Experian Health’s Patient Access Curator, which uses AI and machine learning to streamline front-end data collection at registration, including eligibility verification, coordination of benefits (COB), Medicare beneficiary identifiers (MBI), insurance discovery and demographic verification in real time.

In fact, 83% say they would replace their current technology if it delivered a compelling return on investment. Nearly two-thirds (64%) indicate they definitely or probably plan to invest in AI for claims and denial management.

Additionally, healthcare providers are doing the following to reduce claim denials:

• Upgraded/replaced claims technology (48%)
• Automated or expanded portal claim reviews (40%)
• Digitized registration & automated payer-policy tracking (37%)

Access the free Experian Health 2026 State of Claims report here. The survey was conducted among 204 healthcare professionals responsible for financial, billing or claims management decisions.

About Experian Health

At Experian Health, we serve more than 60 percent of U.S. hospitals and more than 5,800 medical practices, labs, pharmacies and other healthcare providers to simplify healthcare with data-driven platforms and insights that help our clients make smarter business decisions, deliver a better bottom line and establish strong patient relationships.

Experian is a global data and technology company, powering opportunities for people and businesses around the world. We invest in talented people and new advanced technologies to unlock the power of data and to innovate. A FTSE 100 Index company listed on the London Stock Exchange (EXPN), we have a team of 25,200 people across 33 countries. Our corporate headquarters are in Dublin, Ireland. Learn more at experianplc.com.

For more information about Experian Health, visit http://www.experianhealth.com. Learn more about Experian at www.experianplc.com.

Fonte: Business Wire