Claim Denials Are Still Rising in 2026: What Experian's State of Claims Survey Means for Your Practice

Claim denials rising in 2026 are the headline of Experian Health's State of Claims survey, released October 28, 2026. 75% of the 204 providers surveyed say denials are increasing, and 68% say denial rates run higher than a year ago. 40% have 10% or more of claims denied, a rate that has barely moved from 41% in 2025 and sits 9 points above the 31% recorded in 2022.

Your practice feels this as cash that arrives late or never arrives at all. A denied claim costs rework time, delays payment by weeks, and carries a real chance the money never comes back.

Only 30% of providers recover 80% to 100% of denied revenue, per Medical Economics coverage of the survey published October 30, 2026. The rest write off part of every denial.

The fix starts before the claim goes out. This article works through the survey numbers, prices a 10% denial rate in dollars, and gives you a fix for each denial reason, with the exact words to put in your notes and appeal letters.

Table of contents

• What Experian found: denials are still rising in 2026
• "Services not covered" is now the top denial reason
• What a 10% denial rate costs your practice
• The recovery gap: winning the appeal still loses money
• Prior authorization is the second front
• What the rest of the 2026 data says
• Fix it by denial reason
• Write notes and appeals that win
• Your 30-day denial checklist
• What this means for your revenue
• Frequently asked questions

Key takeaways

• Claim denials are still rising in 2026. 75% of providers in Experian Health's State of Claims survey say denials are increasing, and 40% have 10% or more of claims denied.
• "Services not covered" is the top denial reason for the first time since the survey began in 2022. It shows up in 53% of respondents' top three reasons.
• Only 30% of providers recover 80% to 100% of denied revenue. 52% recover only 50% to 70%, per Medical Economics on October 30, 2026.
• A 10% denial rate costs a practice that files 1,000 claims a month $102,240 a year in lost revenue and rework. Cutting it to 6% saves $40,896 a year.
• Prior auth pressure runs on a second front. The AMA's 2025 survey found 32% of physicians say requests are often or always denied, and 74% say denials rose over the past 5 years.

What Experian found: denials are still rising in 2026

Experian Health fielded its fourth annual State of Claims survey August 5 to 23, 2026, among 204 healthcare staff who handle finance, billing, registration, reimbursement, claims, and collections. The report landed October 28, 2026, and the headline number barely moved.

40% of providers say 10% or more of claims are denied, against 41% in 2025, 38% in 2024, and 31% in 2022. 14% say more than 15% of claims are denied.

A flat rate at the top of the range is not good news. 68% say denials run at a higher rate than a year ago, and 75% say denials are increasing.

89% now rank denial reduction as an organizational priority, up from 82% in 2025 and 76% in 2022. That is the highest priority reading since the survey began.

The pressure sits on both sides of the claim. 79% say payer reimbursement is harder to secure, up from 76% in 2025.

79% say economic conditions make payer reimbursement more urgent, the highest result since the survey began. 75% say they are very or somewhat concerned about reimbursement from payers and patients over the next 12 months, per Medical Economics.

Clean claims got harder to file. 65% say submitting clean claims is harder now than it was 12 months ago.

64% say the time to reimbursement is increasing. 53% say errors in submitted claims are on the rise.

And 69% say their organization manages denials quickly and well, down from 75% a year earlier. Your revenue cycle management process has to carry more rework with the same staff, and the numbers show it is slipping.

The second Experian summary of the same survey, published October 28, 2026, puts it plainly: denied claims remain high, and they put revenue and patient trust at risk. MedCity News covered the release on November 6, 2026, and reached the same read: providers struggle to keep up with payer rules while protecting reimbursement.

Your clean claim rate benchmark is the number to watch here. If clean claims fall, denials follow a month later. Track it weekly, not quarterly.

"Services not covered" is now the top denial reason

The survey's biggest shift is which reason tops the list. "Services not covered" now ranks first, the first time it has done so since the survey began in 2022. It appears in 53% of respondents' top three denial reasons, well ahead of frequently changing payer policies at 31%.

Code errors and prior auth problems tie at 25% each.

A service your practice has billed for years can get denied overnight when a plan narrows a coverage policy or adds an auth requirement. Nothing about the care has to change. The claim fails because the coverage rule changed under it.

That is why 78% say payer policy changes are more frequent, up from 67% in the survey's first edition in 2022. A former health system chief medical officer, Wael Khouli, M.D., MBA, told Medical Economics in April 2026 that payer policies "change more frequently, with less notice and with greater specificity than they did even five years ago." Prior auth requirements have spread into services that once went through without one, and the bar for medical necessity notes has risen.

One bright spot sits at the front desk. 43% say inaccurate data collected at registration and intake causes 5% or more of their denials, down from 52% in 2025 and 53% in 2024.

Eligibility checks, demographics, and coordination of benefits at intake are paying off. But a single wrong field still delays payment and starts rework.

The how to reduce claim denials post on this site walks through the coverage check that stops this denial before the visit. The clinical vs technical denials post splits denials into the two kinds that need different fixes, which matters because the survey's top reasons split the same way: coverage and policy on one side, codes and auth on the other.

What a 10% denial rate costs your practice

Percentages hide the dollars. Here is the math on a round practice, with every input tied to a published number.

Take a practice that files 1,000 claims a month at $150 average allowed per claim. That is $150,000 in monthly charges. At a 10% denial rate, 100 claims get denied each month, worth $15,000.

Now apply the recovery numbers. 52% of providers recover only 50% to 70% of denied revenue, per the Experian survey covered by Medical Economics. Use 60%, the middle of that range.

$9,000 of the $15,000 comes back. $6,000 never comes back. That is $72,000 a year in lost revenue.

Then add the rework. MGMA research puts the average cost of reworking one denied claim at $25.20, per TheStreet coverage published October 19, 2026. 100 denials a month times $25.20 is $2,520 a month, or $30,240 a year in staff time.

Add the two lines. $72,000 in lost revenue plus $30,240 in rework is $102,240 a year.

That is the annual cost of a 10% denial rate for this practice. Each denied claim costs $85.20 on average: $60 in lost revenue plus $25.20 in rework.

Cut the rate and the savings stack fast. Each point of denial rate is worth $10,224 a year to this practice.

Cutting denials from 10% to 5% saves $51,120 a year. Cutting from 10% to 6% saves $40,896 a year, which covers a $40,000 part-time hire to work denials full time.

These are round illustration numbers, not your numbers. Your average allowed amount and your recovery rate will differ. But the shape holds: a 10% denial rate costs a mid-size practice more than $100,000 a year, and half of it never comes back no matter how good the appeal is.

Run your own numbers with your medical billing services team this week. Pull your denial rate, your average allowed amount, and your recovery rate from the last 90 days.

If you do not track recovery rate, start there. Only 23% of survey respondents track denial rate at all, and only 31% track clean claim rate.

The recovery gap: winning the appeal still loses money

Providers are good at the first half of the appeal. 86% say they successfully resubmit denied claims at least half the time. The second half is where the money leaks.

Only 30% say they recover 80% to 100% of denied revenue. Another 52% say they recover only 50% to 70%.

A successful appeal that pays 60 cents on the dollar is still a 40% write-off. Do that 100 times a month and the write-offs add up to $6,000 a month on the practice in the last section. Khouli put the same point bluntly in Medical Economics: "Around 70% of appealed claims can be successfully overturned. The denials aren't mostly legitimate. Many of them are wrong. But the appeal never got filed, because the team didn't have time, or the filing window closed, or someone made a judgment call that the claim wasn't worth the effort."

The window matters. Every payer sets a timely filing deadline for appeals, and a missed deadline ends the claim. A $400 or $600 claim gets written off because no one had time to appeal it, Khouli wrote, and "that's not a rounding error; that's real money that affects whether payroll gets met."

Your medical billing denial management process needs one rule: file every appeal worth more than the $25.20 rework cost. A $400 claim that takes $25.20 to rework and pays 60% returns $240 for $25.20 of work. That is about a 9 to 1 return.

The claims to write off are the ones below the rework cost, not the ones your team never got around to.

“"Around 70% of appealed claims can be successfully overturned. The denials aren't mostly legitimate. Many of them are wrong."”

Prior authorization is the second front

Denials after the visit are half the story. Prior auth blocks care before it happens, and the AMA's 2025 prior authorization survey shows that front is getting worse too. The AMA surveyed 1,000 practicing physicians in December 2025 and published the results in May 2026.

32% of physicians say prior auth requests are often or always denied. 74% say denials have increased over the past 5 years. Physicians complete an average of 40 prior auths per physician per week, taking 13 hours of physician and staff time.

95% say prior auth delays access to necessary care. 79% say patients at least sometimes abandon treatment. 26% report a serious adverse event for a patient in their care.

The insurer pledge did not move the numbers. More than 60 insurers pledged in June 2025 to fix prior auth, but only 33% of physicians believe the pledge will make a real difference, per the AMA on May 18, 2026.

Only 24% agree that medical-necessity denials get reviewed by a licensed and qualified physician. Only 16% of physicians in peer-to-peer reviews say the plan's peer often or always has the right qualifications.

Medicare Advantage carries its own warning. The HHS Office of Inspector General found in April 2022 that 13% of denied prior auth requests met Medicare coverage rules and would have been approved under original Medicare.

A June 2026 OIG data brief found Medicare Advantage plans overturned 95% of appealed prior auth denials for skilled nursing facility admission, which points to initial denials that should not have happened. The OIG brief covers 19 plans and 109,400 SNF admission requests from June 2024, of which 12% were denied.

Two rule changes land soon. Traditional Medicare started prior auth for a set list of services in 6 states on January 1, 2026, under the CMS WISeR model, per Medical Economics.

And under CMS final rule CMS-0057-F, impacted payers must have electronic prior auth systems live by January 1, 2027. Our 2027 Medicare fee schedule post covers the January 1, 2027 changes in full.

Lawmakers are pushing back on payer AI. 7 states passed laws in 2026 limiting how insurers use AI in coverage decisions. A bipartisan House bill, the Doctors Not AI Act, would bar AI systems from issuing denials that involve clinical judgment.

MGMA endorsed it on October 16, per Medical Economics. A September 2026 MGMA poll found 44% of responding medical group leaders said prior auth turnaround had become slower in 2026 than in 2025.

What the rest of the 2026 data says

Experian is one survey. The rest of the 2026 data points the same way.

Guidehouse and HFMA surveyed 191 healthcare provider executives in late 2025 for their 2026 Revenue Cycle Management Trends report, published April 2026. 88% rank payer problems among their top 3 revenue cycle concerns, and 88% say claims disagreements keep them from getting paid on time and in full. 81% report increasing denials, 74% report more prior auth delays, and 73% see more unclear denial explanations or underpayments.

20% now report denial rates above 5%, up from 12% in the prior survey. The Guidehouse release and Healthcare Finance News both covered the release in April 2026.

The same report shows how little tech is actually in place. 59% of executives have not yet put AI or automation in revenue cycle operations, and 42% are still looking at it.

Only 2% call AI or automation fully or mostly in place across the revenue cycle. Yet 78% are using some automation or AI to speed up manual revenue cycle work, per Healthcare Finance News.

KFF's analysis of CMS transparency data, published March 24, 2026, counts actual claims instead of survey answers. Insurers on HealthCare.gov denied 19% of in-network claims in 2024 and 37% of out-of-network claims, for a combined 20% of all claims. That is about 85 million denied in-network claims out of 451 million filed.

Fewer than 1% of denied claims were appealed, and insurers upheld 66% of the appeals they heard. The KFF brief covers marketplace plans only, not Medicare or employer plans, but the scale is hard to ignore.

The admin cost behind all of this is large. The 2025 CAQH Index estimates the industry avoided $258 billion in admin costs in 2024 through automation, with a $20 billion savings opportunity still on the table.

Becker's Hospital Review asked the obvious question in July 2026: automation paid off, so why are denials still rising? Its answer is that automation cut admin cost without fixing the denial drivers, which are coverage, policy, and auth.

HFMA's benchmark treats a denial rate below 5% as the mark to hit. The average health system manages 110,000 unpaid claims at any given time, and an HFMA benchmark report cited in 2026 coverage puts 90% of denials in the avoidable column. McKinsey's 2025 RCM buyer survey of 215 US healthcare delivery leaders, published April 2026, and Inovalon's 2026 survey of more than 400 revenue cycle leaders both point the same way: teams want earlier intervention, before the claim goes out, per a 2026 research roundup.

Denials also stretch your days in AR. A denied claim that takes 60 to 90 days to rework and repay sits in AR the whole time.

Cut denials and AR days fall with them. Our revenue cycle management services post covers the full cycle that denials drag down.

Fix it by denial reason

One fix does not cover all five denial reasons. Match the fix to the reason, and give each fix one owner.

Start with the top reason. Pull your denials from the last 90 days, group them by reason code, and rank the reasons by dollars, not by count.

A $600 denial that repeats 20 times a month is a $12,000 monthly problem. A $40 denial that repeats 100 times is a $4,000 problem. Fix the $12,000 one first.

Then fix the process that made it, not the claim. If coverage denials lead, the fix sits at scheduling and intake, not in the billing office.

If code errors lead, the fix sits in the note and the coder's check, not in the appeal. If auth denials lead, the fix sits in the auth queue, not in the resubmission pile.

Only 31% of survey respondents track time spent on appeals against the amount recovered, and only 23% track denial rate. Pick 3 numbers and track them weekly: denial rate, clean claim rate, and dollars recovered per appeal hour. Those 3 tell you whether the fixes work.

Write notes and appeals that win

Vague notes lose appeals. The note has to carry the medical necessity case in plain words, with dates and facts a reviewer can check. Use these shapes and fill in the brackets.

For medical necessity, write: "Patient completed 6 weeks of physical therapy twice weekly and daily NSAIDs with no relief. MRI dated October 12, 2026, shows [finding]. [Procedure] is medically necessary because conservative care failed and the imaging supports the diagnosis."

For a prior auth request, write: "Requesting [procedure, CPT code] for [diagnosis, ICD-10 code]. Patient tried [treatment] from [start date] to [end date] with no improvement. Attached: office notes dated [date], imaging, and prior treatment records."

For an appeal letter, open with: "We request reconsideration of claim [number], date of service [date], denied as services not covered. The service is covered under plan section [section] because [reason]. Enclosed: [documents]. Please reprocess and pay $[amount]."

For a same-day visit with modifier -25, write: "Separate E/M today for [problem]: history, exam, and medical decision making distinct from the [procedure]. Modifier -25 appended."

Each one names the service, the dates, and the reason in the first lines. A reviewer reads dozens of appeals a day.

The ones that win state the case in the first paragraph and attach the proof. The ones that lose ask the reviewer to go find it.

Your 30-day denial checklist

What this means for your revenue

Claim denials rising in 2026 are not a one-year spike. 75% of providers say denials are increasing, 40% have 10% or more of claims denied, and the rate has sat near the top of the range for 2 years.

Coverage denials lead for the first time. Payer policies change faster than most teams track them. Prior auth eats 13 hours a week per physician.

The practices that come out ahead treat denials as a prevention problem. Verify coverage before the visit. Check auth dates before the claim goes out.

Match codes to the note.

Track payer policy changes with one owner. File every appeal worth more than the rework cost.

Run the math from this article on your own numbers. If your denial rate is 10% and you file 1,000 claims a month, you are losing about $102,240 a year.

Cutting it to 6% saves $40,896. That is a hire, a raise, or a new piece of equipment, paid for by claims you already earned.

Get a free audit of your last 90 days of denials. We price your denial rate, your recovery gap, and your rework cost in 48 hours, and we show you the 3 fixes worth the most money.

Frequently asked questions

Sources

• Experian Health, State of Claims 2026: Why denials remain an uphill climb, November 6, 2026: https://www.experian.com/blogs/healthcare/state-of-claims-2026-why-denials-remain-an-uphill-climb/
• Experian Health, Healthcare claim denial statistics: State of Claims Report 2026, October 28, 2026: https://www.experian.com/blogs/healthcare/healthcare-claim-denials-statistics-state-of-claims-report/
• Medical Economics, Why are claims being denied in 2026? Services not covered now tops the list, October 30, 2026: https://www.medicaleconomics.com/view/why-are-claims-being-denied-in-2026-services-not-covered-now-tops-the-list
• MedCity News, Experian Health Survey: Providers Struggle Amid Increasing Claim Denials, November 6, 2026: https://medcitynews.com/2026/11/experian-health-survey-providers-struggle-amid-increasing-claim-denials/
• American Medical Association, Only 1 in 3 doctors trusts insurers' prior authorization promises, May 18, 2026: https://www.ama-assn.org/practice-management/prior-authorization/only-1-3-doctors-trusts-insurers-prior-authorization
• KFF, Claims Denials and Appeals in ACA Marketplace Plans in 2024, March 24, 2026: https://www.kff.org/patient-consumer-protections/claims-denials-and-appeals-in-aca-marketplace-plans-in-2024/
• Guidehouse, Survey: Resolving payer relations is a top priority for healthcare providers, April 1, 2026: https://guidehouse.com/news/healthcare/2026/resolving-payer-relations?cn-4
• Healthcare Finance News, Payer denials and prior authorization delays are top RCM concerns, April 8, 2026: https://www.healthcarefinancenews.com/news/payer-denials-and-prior-authorization-delays-are-top-rcm-concerns
• Becker's Hospital Review, Automation Paid Off, So Why Are Denials Still Rising?, July 14, 2026: https://www.beckershospitalreview.com/finance/revenue-cycle-management/automation-paid-off-so-why-are-denials-still-rising/
• HHS Office of Inspector General, Medicare Advantage Organizations Overturned Nearly All Appealed Prior Authorization Denials for Skilled Nursing Facility Admission, June 2026: https://oig.hhs.gov/documents/audit/11694/OEI-09-24-00331.pdf
• TheStreet, This AI startup is betting it can end insurance claim denials, October 19, 2026: https://www.thestreet.com/crypto/artificial-intelligence/doctors-keep-losing-to-insurance-paperwork-this-ai-startup-built-them-a-weapon
• Centers for Medicare and Medicaid Services, Calendar Year 2027 Medicare Physician Fee Schedule Final Rule fact sheet, November 4, 2026: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2027-medicare-physician-fee-schedule-final-rule