The State of Claims 2025: The Problem of Denial (and Is AI the Answer?)
The State of Claims 2025: The Problem of Denial (and Is AI the Answer?)
By natalie lima | Published: 2025-09-23 10:00:00 | Source: Healthcare Blog
Main takeaways:
- Experian Health Claims Status Report 2025 Now released, it details providers’ views on claims management and how they have changed since the survey began in 2022.
- Claim denials continue to rise, prompting providers to find faster and more efficient ways to submit claims clean the first time.
- When it comes to solutions, optimism about AI is high, but uptake remains surprisingly low.
- Artificial intelligence-powered tools such as Patient Access Trust and Artificial Intelligence feature It can help healthcare providers reduce claims denials while improving the claims management process.
according to Experian Health 2025 Claims Status Reportclaim denial continues to negatively impact America’s health care providers. This quantitative survey of 250 healthcare professionals, conducted in June and July 2025, reveals providers’ concerns about high denial rates, staffing shortages, and uncertainty about whether payers or patients will ultimately pay. Show results That providers are open to processing new claims and solutions to reduce denials. However, while providers are excited about AI’s ability to relieve stress, only a small percentage are actually using it.
This article highlights some key points from healthcare providers’ statements about current challenges in claims management and factors contributing to their responses.
Takeaway 1: Claim denials are on the rise again
This year’s poll It confirms what providers have seen for many years: Claims denials don’t stop. In 2022, 30% reported that at least 10% of their claims were denied. By 2024, the number has risen to 38%. Now, in 2025, 41% of providers say their claims are denied more than 10% of the time. If this trend continues, how high could denial rates rise?
Claims denials have become an increasing part of daily operations, requiring more time, staff and resources. Margins that are already under pressure They are exposed to more stress due to non-payment of costs. And when insurance companies don’t pay, more of the bill falls on patients, many of whom are already struggling to manage medical costs. Half of survey respondents said they were “very or very concerned” about patients’ ability to pay. An increase of six percentage points over last year. For many organizations, the question is not whether rejection will persist, but how best to prevent it before the financial burden worsens.
Takeaway 2: How bad data leads to more health care claim denials
Report lists Many are the most important drivers of rejection, but inaccurate and incomplete data remain prominent. More than half of providers (54%) say claims errors are increasingNearly seven in ten (68%) said filing clean claims was more difficult than it was a year ago.
Many of these errors arise when registering. Incomplete or inaccurate information collected during check-in became the third most common reason for denials, with 26% of respondents saying that at least one in ten denials in their organization could be traced to receiving errors. Each error sends ripples downstream, resulting in costly rework, avoidable payment delays, and unnecessary stress on the patient.
Tightening patient access processes and collecting accurate data is one of the best things providers can do to reduce denials. With that in mind, Patient Access Curator at Experian Health It’s designed to help providers capture accurate data the first time. Using artificial intelligence and machine learning, it integrates eligibility checks, benefits coordination, and verification of Medicare Beneficiary ID (MBI), demographics, insurance coverage, and financial status into a single workflow. This allows service providers to:
- Quickly collect accurate patient information in advance
- Eliminate the need to rerun eligibility checks, which now take more than 10 minutes for more than half of providers
- Reduce manual data entry errors that lead to downstream rejections
- Free up employee time for higher value tasks
Takeaway 3: The Paradox of AI in Healthcare Claims: High Optimism, Low Adoption
The Patient Access Curator is a great example of this How AI can help address the data issues behind denials. But clean data alone is not enough. Mistakes and risks still appear mid-cycle. here, Artificial intelligence feature It offers another application of artificial intelligence, which uses predictive analytics to identify high-risk claims before they are submitted and guide them to correction. It also sorts rejections based on payment probability, so that employees don’t waste time redoing unproductive work.
69% of healthcare providers using AI say that AI solutions have reduced denials and/or increased resubmission success.
Claims Status Report 2025 | Experian Health
Scanning It shows that many providers are excited about the potential of AI: 67% believe AI can improve the claims process, and 62% are very confident in their understanding of how AI differs from automation and machine learning, up sharply from just 28% in 2024.
Despite this optimism, the adoption rate is surprisingly low. Only 14% of providers currently use AI To reduce denials. The survey indicates that although the majority of AI users report fewer rejections and more successful resubmissions, fear of the unknown appears to slow progress.
Idea 4: Technology upgrades are not enough without integration
Even if they remain neutral about AI, providers are still moving to modernize claims management. Only 56% believe their current technology is sufficient to handle revenue cycle requirements, A significant drop from 77% in 2022. This explains why 55% of companies would be willing to completely replace their current claims management platform if a compelling return on investment was offered.
A lot of frustration comes from fragmentation. almost Eight out of ten providers They say their organizations still rely on multiple solutions to collect the information needed to file a claim. Switching between systems slows down the reception process, creates duplication and increases the risk of errors that directly lead to rejection.
Integrated solution such as Patient Access Secretary It solves this problem by replacing a suite of tools with a single platform that manages admissions and eligibility in a single workflow. Information is captured in one place, reducing duplication and errors that are inevitable when entering data into multiple databases. Extend this with Artificial intelligence feature It connects front-end resolution with back-office information, giving providers a connected system to prevent denials rather than clumping together siled fixes. With fewer tools to log into, employees can work more efficiently and focus on submitting cleaner claims.
Learn how Experian Health is reshaping the way health systems manage benefits coordination. Learn how automation and AI eliminate manual errors, reduce rejections and unlock millions in recoverable revenue.
Closing technology gaps in claims management to prevent denials
the Claims Status Report 2025 It clearly shows that denials remain a persistent and costly problem for healthcare organizations. The overwhelming majority say reducing them is a top regulatory priority.
Aside from financial concerns, The survey reveals a system that remains broken by data errors, fragmented technology, and delays. At the same time, there are signs of cautious optimism. Last year, many providers felt ignorant about AI and machine learning. This year’s survey shows that awareness of these technologies has increased significantly, even if their adoption is still early. While the report highlights how leaders should evaluate investments in new technology, the question now is whether service providers can turn growing confidence in AI into action that delivers the results they need.
To see the full picture of where claims management is today, and where it can go next, Download the 2025 Claims Status Report.
(tags for translation) ai
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