41% of Providers Now See 1 in 10 Claims Denied: The 2025 to 2026 Denial Data

The denial numbers

Every figure is sourced and dated. Use them, and link the sources when you cite them; the primary references are listed at the foot of this page.

The denial reasons, ranked

"Bad data" is the headline, but it pays to see the actual order, because each reason has a different owner and a different fix. Assigning a denial to the right owner is half the battle.

The top three, data, registration, and authorization, are all captured before or around the visit, which is why the front desk and verification steps carry so much of the denial-prevention load. A denial is not a billing problem that starts in billing; it is usually a front-end problem that surfaces in billing weeks later.

The trend: worse every year since 2022

The single most telling number here is not the level, it is the slope. The share of providers who say more than one in ten of their claims is denied has climbed every single year the survey has run: 30% in 2022, 38% in 2024, and 41% in 2025 Experian, 2025. That is not a bad year. It is a direction. Alongside it, 54% of providers now say denials are actively increasing and 68% say clean claims are harder to submit than a year ago. When a majority reports the same worsening on three separate measures, the reasonable planning assumption is that denials keep rising, and that a practice which does nothing will see its denial rate drift up with the tide.

Denials by payer

An overall denial rate hides where the pain actually is. Broken out by payer, 2026 reporting puts initial denial rates at roughly 15.7% for Medicare Advantage, 16.7% for Medicaid, and 19.1% for ACA marketplace plans, all well above the blended industry figure near 11.8%. The pattern matters for two reasons. First, it tells you where to focus: if a large share of your volume sits with a high-denial payer, your effective exposure is worse than the average suggests. Second, it explains why practices with similar processes can have very different denial rates, payer mix alone can move the number several points. Read your own denials by payer before you conclude your process is the problem; sometimes the process is fine and the mix is punishing.

What counts as a good denial rate

To know whether your denials are a problem, you need a benchmark and a way to measure your own. Best-in-class revenue cycles hold initial denial rates around 5% or below. The industry blended figure sits near 11.8%. And once you are consistently above 10%, you are in the range 41% of providers now report, and losing real revenue to rework and write-offs. Calculate yours simply: divide the number of claims denied by the number of claims submitted over the same period. Do it twice, once by claim count and once by dollar value, because a practice can have a modest count rate and a painful dollar rate if its denials cluster on high-value services. Track it monthly and broken out by payer, and the number stops being a vague worry and becomes a metric you can actually move. A rate drifting up quarter over quarter is an early warning; a rate concentrated in one payer or one service line tells you exactly where to look first.

What denials cost your practice

National totals are abstract. Here is how to make the numbers concrete for your own practice, using round figures you can replace with your real ones. Take a practice submitting 2,000 claims a month. At an 11.8% initial denial rate, that is about 236 denials a month. The administrative cost to rework each one runs around $57.23 Premier, 2023, so the rework labor alone is roughly $13,500 a month, or over $160,000 a year, just to fight for money you already earned. And that is only the visible cost. The larger loss is the denials that are never reworked at all: nationally, a large share of the estimated $262 billion in annually denied claims is never resubmitted, and every unpursued denial forfeits the full claim value, not just the rework cost. For most practices the money lost to abandoned denials dwarfs the money spent reworking the rest. Run this calculation on your own volume and denial rate, and the case for prevention usually makes itself.

Why bad data is the root cause

Read the numbers as a set and they tell one clear story. Denials are rising, they are rising across payers, and the cause is boring: bad data. The single most important figure here is the cause. Half of providers name missing or inaccurate data as the top driver Experian, 2025, ahead of authorization issues and incomplete patient information. That is genuinely good news, because it means most denials are not clinical disputes you argue after the fact. They are capture failures, a wrong member ID, an unverified eligibility, a coding mismatch, that you can prevent before you submit. A denial caused by bad data is a denial you had the power to stop, which reframes the whole problem from an unavoidable cost into a solvable process gap.

Turning the data into fewer denials

If bad data is the driver, the fix is front-end discipline, applied in a specific order. Verify eligibility before the visit, so an inactive plan or wrong member ID never reaches a claim. Capture patient and insurance information accurately at intake. Confirm prior authorizations and record their expiration dates. Check that codes support each other before submission. Then, for the denials that still slip through, work them systematically before their appeal deadlines rather than letting them age out. That is the same capture-first thinking behind the eligibility verification checklist, the denial prevention system, and the five prior auth mistakes that get claims denied. For the prior-auth-specific numbers behind this, see the 2026 prior authorization statistics; for how often the denials you do fight get overturned, see the appeal success data; and to actually work them, the free denial and AR tracker.

Where to go next

• Insurance Eligibility Verification Checklist (Free Download) live

  A free insurance eligibility verification checklist: the pre-visit checks for coverage, IDs,.

• Reduce Prior Auth Denials: The Log + Prevention Checklist System live

  Reduce prior auth denials: a prevention checklist that stops the common causes before.

• 5 Prior Auth Mistakes That Get Claims Denied (and the Fix for Each) live

  Five prior authorization mistakes that get claims denied, and the exact fix for each. Half of.

Frequently asked questions