Health Care Claims Denial Statistics: 2025 State of Claims Report

Main takeaways:

• As claim denial rates continue to rise, pressure is increasing on healthcare organizations to find new ways to reduce denials.
• Leverage artificial intelligence (AI) and automation-based tools, such as Experian Health Artificial Intelligence feature and Patient Access Trust Solutions, proven to reduce rejection rates.
• More than half of the survey participants They say they will replace existing claims management platforms if presented with a compelling ROI for making the change.

Deny the claim It represents a well-documented challenge for healthcare organizations. Denied claims take much longer to pay than first claims, if they are paid at all. Each one means additional hours of rework and follow-up, drawing additional resources as employees review payer policies and figure out what went wrong. It is time consuming and expensive. Beyond dollars and paperwork, denials impact patient care, as uncertainty about payments leads to treatment delays or unexpected out-of-pocket costs.

But how do healthcare leaders feel about the state of claims management today? How do they deal with the administrative burden? Is there light at the end of the tunnel of denial? Experian Health was surveyed 250 healthcare revenue cycle leaders To find out.

the Claims Status Report 2025 It details the survey results, including insights into how automation and AI technology can be used (or not!) to improve the claims process to prevent denials and increase revenue.

What is the current denial rate for health care claims?

Health claims remain stuck in a cycle of denials, delays and data errors. 41% of survey participants At least one in 10 claims are denied, he said. That’s a lot of rework and lost revenue that providers were relying on.

In 2009, claims processing accounted for about $210 billion in “wasted” health care dollars in the United States. A decade later, The bill rose to $265 billion. Industry reports — including Experian Health’s State of Claims series — have repeatedly noted rising denial rates.

today, 54% of service providers We agree that claims denials are increasing. With this increase, providers are constantly concerned about who will pay and when.

What are the most common reasons for denial of health care claims?

According to Clear claim status From participants, the top three reasons for denial were missing or inaccurate data, authorizations, and inaccurate or incomplete patient information. short? The problem is bad data.

26% say so 10% of negation As a result of inaccurate or incomplete data collected at patient intake. Given the amount of information that must be processed and organized to fill out a single claim, this is not surprising. From patient information to changing payer rules, the sheer volume of data points that will be collected and compared creates too many opportunities for errors and oversights.

Other challenges, such as coding errors, uncovered services, eligibility checks, and Staff shortage It still plays a role, but it’s clear that solving the data problem can make a meaningful impact on the rejection problem.

Can automation improve claim denial statistics?

To help Break the cycle of denialmore health care providers are turning to it Claims management software. Leveraging technology helps organizations resolve or prevent obstacles that interfere with claims processing and billing workflows – enhancing claims success rates. About half of the providers You’re still manually reviewing claims.

However, despite the proven benefits of integrated workflow and automation, the drive to implement new technology appears to have lost momentum.

In 2025, 41% of survey participants They say they have upgraded or replaced their claims management technology in the past year. However, 56% say current claims technology is sufficient to meet revenue cycle requirements – far lower than 77% in 2022.

While some tasks still truly require a human touch, employees’ time is often wasted on repetitive, process-driven activities that could be better handled through automation.

Here are some ways claims automation can help Improved claim rejection statistics:

• Connect the entire claims process from start to finish: Using an automated and scalable claims management system – e.g Claim Source® – Helps providers manage the entire claims cycle in one application. From importing claims files for faster processing to automatically formatting and sending claims to payers, it simplifies the claims editing and submission process to enhance productivity.
• Provide more accurate claims: 68% of survey respondents say filing clean claims is more difficult than it was a year ago. There is a strong case, then, for using an automated claims scrubber to reduce errors. Demand washing Reviews pre-billed claims line by line so errors are caught and corrected before they are submitted to the payer, resulting in fewer overcharges and denials and better use of staff time.
• Improve cash flow: Automating claim status monitoring is one way to speed up claims processing and payment time. Improved claim status Eliminates manual follow-up so staff can process pending, returned to provider, declined, or non-payment transactions as quickly as possible.
• Reduce denial: The workflow manager rejects It automates the rejection process to eliminate the need for manual reviews. It helps employees identify denied claims that can be resubmitted and tracks the root causes of denials to identify trends and improve performance. It also integrates with Source of claim, Improved claim status and Contracts Managerso employees can view claim and denial information on one screen.

Improve claim denial statistics using AI

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

Subordinate 14% of survey participants Of those who said their organizations currently use AI, 69% said AI solutions have enhanced claims success rates, resulting in fewer denials and/or increased success of resubmissions.

present Source of claim Users can now upgrade their entire claims management system with Artificial intelligence featurewhich interprets historical claims data and payer behavior to predict and prevent denials. The video below provides a helpful explanation of how to do this Advantages of artificial intelligence Two offerings, denial prediction and denial triage, can help providers respond to the growing challenge of denials.