Claim Denials Increasing as Providers Struggle With Staffing and Data Issues, Survey Finds

Claim denials are rising sharply among health care providers, with 41% reporting denial rates over 10%, according to Experian Health’s 2025 State of Claims survey. The report, based on responses from 250 professionals in finance, billing, and claims management, highlights mounting challenges related to data quality, staffing shortages, and the implementation of technology.

The top 3 reasons for claim denials remain consistent: missing or inaccurate data (50%), issues with prior authorizations (35%), and incomplete or incorrect patient registration information (32%). More than half of respondents (54%) reported an overall increase in claim errors compared to the previous year, while 68% said submitting clean claims has become more difficult.

Staffing remains a contributing factor, with 43% of respondents saying their organizations are understaffed in key operational areas, which affects claims accuracy and resolution times.

Most providers (82%) identified reducing claim denials as a top organizational priority. While 67% of respondents believe artificial intelligence (AI) could help manage the claims process, only 14% currently use the technology. Among those who do, 69% said AI has either reduced denial volume or improved resubmission success rates.

Still, concerns persist. Providers cite skepticism over AI’s accuracy, complexity of implementation, and challenges with Health Insurance Portability and Accountability Act (HIPAA) compliance as barriers to adoption. Additionally, many question AI’s ability to navigate payer-specific requirements.

The survey highlighted the high manual burden of resubmitting denied claims. Nearly 90% of resubmissions still involve some level of human intervention, suggesting inefficiencies that AI may eventually help resolve.

Clarissa Riggins, chief product officer at Experian Health, noted, “The sustained increase in claim denials, coupled with persistent data quality issues, paints a clear picture that providers need to lean into technology and AI’s potential to address these challenges.”

The findings suggest a growing urgency for providers to invest in more sophisticated data tools and AI systems to improve claims accuracy and reduce administrative overhead.

Reference

Minemyer P. Providers say claim denials continue to rise, Experian survey finds. Fierce Healthcare. Published September 24, 2025. Accessed October 10, 2025. https://www.fiercehealthcare.com/providers/experian-study-providers-say-claims-denials-continue-rise