From Denial To Dollars

Payer denial of claims is a stubborn problem. Recent research found that employer-sponsored health plans denied 21% of claims. This is 20% for marketplace plans, 10% for Medicare, and 12% for Medicaid (see Health Insurance Denial Rates by Company).

These statistics are mirrored by provider organization executives who report that at least one in ten claims is denied. But according to a recent survey—The Denial Problem (And Is AI The Answer?): 2025 State Of Claims—this is not only a health plan problem. Half (50%) said that claims submitted had missing or inaccurate claim data. In addition, 24 . . .