Services not covered is the top claim denial reason in 2026, listed among their top three by 53.0% of respondents in Experian Health's fourth annual State of Claims survey. It is the first time that reason has ranked first since the survey began in 2022.
Experian surveyed 204 healthcare staff responsible for finance, billing, registration, reimbursement, claims and collections between August 5 and August 23, 2026, and released the results on October 28. Medical Economics reported that the survey does not split results by organization type, so the figures describe provider organizations in general and not only physician practices.
Denial reasons ranked by respondents
Respondents picked the reasons that appear most often on their denials. Services not covered led at 53.0%. Frequently changing payer policies came second at 31.0%, and two reasons tied for third at 25.0% each: inaccurate codes and difficulty getting prior authorization.
| Denial reason | Share of respondents ranking it in their top three |
|---|---|
| Services not covered | 53.0% |
| Frequently changing payer policies | 31.0% |
| Code inaccuracy | 25.0% |
| Difficulty obtaining prior authorization | 25.0% |
Source: Medical Economics, October 30, 2026, reporting Experian Health's 2026 State of Claims survey (n=204).
Experian's press release lists the same drivers in the same order: services not covered, missing coverage information, coding errors, changing payer policies and prior authorization problems. Coverage can be checked before the visit, so a front desk team has a direct way to reduce the first item on the list.
Denial rates have stayed near 40% for three years
In 2026, 40.0% of respondents said 10% or more of their claims are denied. The 2025 figure was 41.0%, the 2024 figure was 38.0%, and the 2022 figure was 31.0%. Another 14.0% said more than 15% of their claims are denied. Experian's press release describes the 40.0% figure as largely unchanged from last year.
| Survey year | Respondents with a 10%+ denial rate | Respondents calling denial reduction a priority |
|---|---|---|
| 2022 | 31.0% | 76.0% |
| 2024 | 38.0% | Not stated in source |
| 2025 | 41.0% | 82.0% |
| 2026 | 40.0% | 89.0% |
Source: Medical Economics, October 30, 2026, reporting Experian Health's State of Claims surveys.
Three-quarters of respondents (75.0%) agreed that denials are increasing, and 68.0% said their denial rate is higher than a year ago. The share calling denial reduction a priority reached 89.0%, the highest since the survey started.
Payer policy changes and clean claims
Experian found that 79.0% of respondents say getting reimbursement is more difficult, up from 76.0% in 2025. Another 78.0% say payer policies change more often, against 77.0% in 2025 and 67.0% in the 2022 survey. Time to reimbursement is growing for 64.0%.
Claim quality is slipping at many sites. Some 65.0% said submitting a clean claim is harder than it was 12 months ago, and 53.0% said errors in submitted claims are increasing. Only 69.0% said their organization manages denials quickly and efficiently, down from 75.0% a year earlier.
Registration data is one place where the trend improved. The share of respondents who said inaccurate registration and intake data causes 5% to 15% or more of their denials fell to 43.0%, from 52.0% in 2025 and 53.0% in 2024.
Appeals and recovery rates
Most respondents get denied claims paid on the second try. Experian found that 86.0% successfully resubmit denied claims at least half the time. Recovery of the lost revenue varies: 30.0% said they recover 80% to 100% of denied revenue, and 52.0% said they recover only 50% to 70%.
Few organizations measure the cost of that work against what it returns. In the survey, 31.0% track time spent on appeals against the amount recovered, 31.0% track clean claim rate, 23.0% track denial rate and 16.0% track appeal time alone. Medical Economics also quoted Wael Khouli, M.D., who said around 70% of appealed claims can be successfully overturned.
Technology use and plans
Use of automation fell in 2026. Robotic process automation use dropped to 20.0% from 25.0% in 2025, and AI use in claims dropped to 9.0% from 14.0%. Intent runs the other way: 64.0% said they definitely or probably plan to invest in AI for claims and denial management, and 84.0% believe AI can improve claims management in some capacity.
On how far AI can go, 38.0% said it can dramatically change the claims process and another 38.0% said it can but will take a while. Some 8.0% said it is likely only for organizations that can afford the investment, and 11.0% said it cannot. Experian also reported that 83.0% would replace their current technology if it delivered a compelling return on investment.
Cohere Health's Brian Covino, M.D., told Medical Economics that real-time prompts have cut missing-information issues by 30% to 40% in his company's experience. The figure comes from the vendor and is not part of the survey.
Respondents named the denial reduction steps they took in the past year. Upgrading or replacing claims technology led at 48.0%, followed by automating or expanding portal claim reviews at 40.0%. Digitizing registration and automating payer policy tracking each reached 37.0%, and providing accurate patient estimates reached 27.0%.
Experian also found that 79.0% agreed that economic conditions make payer reimbursement more urgent, the highest result since the survey began, and 75.0% said they are very or somewhat concerned about reimbursement from both payers and patients over the next 12 months.
Sources
- Medical Economics, Why are claims being denied in 2026? "Services not covered" now tops the list, October 30, 2026
- Experian, Experian Health's Annual State of Claims Survey Finds Denials Remain Elevated As Reimbursement Challenges Grow, October 28, 2026
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