Providers say claim denials are on the rise, with issues in data quality and the availability of technology driving the trend, according to a new survey.
Experian Health released its annual State of Claims report, polling 250 professionals in finance, billing or claims management. It found that 41% of providers now see denial rates upward of 10%, a figure that has compounded over the past several years.
More than half (54%) said there is an increase in claim errors, while 68% said it is more difficult to cleanly submit claims compared to a year ago. In addition, 43% of respondents said they are understaffed, which also contributes to the problem.
“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,” said Clarissa Riggins, chief product officer at Experian, in a press release.
Most providers (82%) name reducing claim denials as a key priority. The study cites three top reasons for denials, which have remained the leading issues for the past three years: missing or inaccurate data (50%); authorizations (35%); and incomplete or inaccurate patient registration data (32%).
Two-thirds (67%) said they believe artificial intelligence could play a key role in managing the claims process more effectively, but overall adoption is low, per the survey. Sixty-eight percent of respondents said they are "well-versed" in the technology, but only 14% deploy it.
Within that group, 69% have said that using AI has decreased the number of denials or increased the success rate of resubmissions.
For those who haven't adopted the tech, they cited unproven accuracy and concerns around HIPAA compliance as the key reasons for doing so. They also fear that the training required for AI may be too complex for their teams.
Providers also expressed skepticism that AI can address payer-specific claim requirements.
However, given that managing resubmissions requires significant manual effort—the study found 90% of resubmissions are addressed with at least some human input—AI still holds promise in making the process much easier, the researchers said.
“Our survey underscores that AI is no longer just a theoretical solution, but it’s a vital tool that can break the pervasive cycle of denials, delays and data errors," Riggins said.