Healthcare providers are putting more resources into preventing claims denials, but a new survey from Experian Health suggests those efforts are not yielding results.
The 2026 State of Claims survey, released last week by the Dublin, Ireland-based global data and technology company, included responses from 204 healthcare professionals responsible for billing and claims management. According to Experian’s report, 75% of respondents said that claim denials are increasing, and 40% of them say that at least 10% of their claims are denied. Those numbers are largely unchanged from last year.
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The findings point to a persistent hurdle for health systems already facing increased workloads and staffing challenges: keeping up with the complex and ever-changing payer requirements while protecting reimbursement. According to the survey, 78% of providers say that payer policies are changing more frequently, compared to 67% in 2022. Nearly the same number of respondents – 79% – said that securing reimbursement has become more difficult in the past year. More than two-thirds reported that denials rates are higher than a year ago, and a whopping 89% of providers said that reducing denials is a priority in 2026.
Mindy Fortson, CEO of Experian Health, believes that the disconnect reflects a gap between the complexity of claims management and providers’ ability to adapt.
“Providers recognize that denials are a growing threat, but their response isn’t keeping pace with the problem,” Fortson said in a press release.
The consequences of each denial extend beyond delayed payments. Every denied claim creates additional work for provider teams, who must then investigate the issue, make corrections, and resubmit the claim. Fortson noted that this often means longer reimbursement cycles and a potential for lost revenue.
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The results also revealed the underlying cause of denials: services not covered emerged as the leading reason, while frequently changing payer policies followed as the second biggest hurdle.
“I think one of the biggest opportunities is on the front end, making sure providers have accurate coverage and patient information before the information moves through the revenue cycle,” Fortson said in an email.
Survey respondents largely cited AI as a potential solution, with 84% agreeing that AI has the potential to improve claims management, and 64% saying that they definitely or probably plan to invest in AI to support claims and denial management.
“Providers see potential in AI, particularly when you look at how much manual work revenue cycle teams are managing today. Technology gives us an opportunity to take some of that repetitive work off their plates,” Fortson said. “The strongest opportunities involve high volumes of repetitive work such as finding missing coverage, identifying issues before submission and reducing manual follow-up on denied or underpaid claims.”
With healthcare costs rising and healthcare teams facing ongoing challenges, claims and denial management remains a growing burden. AI may provide an opportunity to decrease the manual workload associated with the process, but payers, policymakers, and healthcare systems must consider reform to alleviate the broader issue.
“I think one of the biggest challenges is the growing complexity providers are having to manage with teams that are already stretched,” said Fortson. “Payer requirements are changing more frequently, and staff are expected to keep up with those changes while still protecting cash flow and the patient experience.”
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