What’s to blame for claim denials?
Forty-one percent of providers surveyed said they are facing claim denial rates of 10% or higher, up from 38% in 2024, according to a Sept. 22 report from Experian Health.
Experian’s “2025 State of Claims” report is based on a survey of 250 healthcare professionals responsible for financial, billing or claims management decisions. Participants represented a “blend of tactical and executive roles.” The survey was conducted between June 23 and July 3.
The primary triggers for denials remain unchanged from 2024, Experian said, but the percentages shifted “and some are worse.”
The top reasons for denials are:
- Missing or inaccurate claim data: 50%, up from 46% in 2024.
- Authorizations: 35%, down from 36%
- Incomplete or incorrect patient registration data: 32%, up from 30%
- Code inaccuracy: 24%, down from 27%
- Services not covered: 23%, down from 26%.
The report also found that 54% of providers said claim errors are increasing. Sixty-eight percent said submitting clean claims is more challenging than a year ago, and 43% said they are understaffed.
Access the full report here.
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