All posts by Krishna Nelluri
Key takeaways: Claims management is a critical component of the healthcare revenue cycle, directly affecting financial performance and operational efficiency. Increasing complexity across payers, regulations and patient responsibility is making claims management more challenging. Emerging technologies, including automation and artificial intelligence (AI), are reshaping how healthcare organizations manage claims and improve outcomes. Claims management is one of the most pressing challenges in healthcare billing. According to Experian Health’s 2026 State of Claims survey, 75% are very to somewhat concerned about reimbursement from both payers & patients over the next 12 months. Denied or delayed payments can put pressure on providers’ cash flow. The survey also suggests that barriers to on-time payment can arise at the earliest stages of the revenue cycle, in the form of incorrect or incomplete claims and patient registration information. Managing claims efficiently starts with the right data. What is claims management in healthcare? Claims management is the process of preparing, submitting and following up on healthcare claims, to help providers receive appropriate reimbursement for their services. It spans the entire revenue cycle, from verifying coverage during patient intake through final settlement. How does claims management fit into the healthcare revenue cycle? Effective claims management keeps the rest of the revenue cycle on track. But the State of Claims survey suggests many providers are finding this increasingly tough. What are the key stages of the medical claims lifecycle? Each of the following steps is a chance to keep the claim moving: Patient intake and verification Staff collect and verify patient demographic information, insurance details and eligibility at patient intake. If crucial data is missed, a denial is likely. Patient Access Curator™ (PAC) addresses this directly, using AI and robotic process automation to automatically check and verify these details.
Healthcare claim denial statistics: State of Claims Report 2026 Key takeaways: As claim denials remain high, pressure is mounting on healthcare organizations to find new ways to reduce denials. In 2026, 89% of survey respondents say reducing denials is a priority. Artificial intelligence (AI) and automation-based tools, like Experian Health’s AI Advantage™ and Patient Access Curator™ (PAC), can help providers prevent avoidable denials and improve claims workflows. Most survey respondents say they’d replace existing claims management platforms if presented with compelling ROI: 83% say they would fully replace existing technology. Claim denials are a well-documented challenge for healthcare organizations. Denied claims take much longer to pay out than first-time claims, if they get paid at all. Each one means additional hours of rework and follow-up, pulling in extra resources as staff review payer policies and figure out what went wrong. It’s time-consuming and costly. Beyond dollars and paperwork, denials affect patient care as uncertainty about payments leads to delays in treatment or unexpected out-of-pocket costs. But how do healthcare leaders feel about the state of claims management today? How are they tackling the administrative burden? Is there any light at the end of the denials tunnel? Experian Health surveyed 204 healthcare staff responsible for finance, billing, registration, reimbursements, claims and collections to find out. The 2026 State of Claims report breaks down the survey findings, including insights into how automation and AI technology are being used (or not!) to optimize the claims process for denial prevention and improve reimbursement.
Why are healthcare claims denied? Even the smallest mistakes on claims submission can trigger denials. Nearly 70% of providers say submitting clean claims is harder than it was a year ago, and 54% report an increase in claim errors, according to Experian Health’s 2025 State of Claims report. Some common reasons for healthcare claims denials include: Incomplete registration records: 26% of providers report that at least 10% of denials stem from inaccurate or incomplete data collected during registration. Missing patient information: Incomplete or incorrect patient data collected at registration triggers 32% of claim denials, according to Experian Health’s latest State of Claims report. Inaccurate insurance data: Outdated patient insurance information, missing coverage or mistakes made when entering insurance data during registration can lead to rejected or denied claims. Eligibility verification errors: Mistakes during manual eligibility checks or incomplete insurance eligibility verification are common causes of denials. Prior authorization issues: 35% of claim denials are triggered when prior authorizations aren’t obtained or don’t fully meet prior authorization requirements before claims submission. Coding inaccuracies: Missing medical billing codes and coding errors account for 24% of denials. Nearly half of providers say that coding errors are one of the top three most preventable claims errors in the latest Experian Health Claim Denial Management survey. Coordination of benefits (COB) errors: Coordinating benefits across several payers is a complex process and mistakes that lead to denials are common, especially when COB is handled manually.
Understanding contract management for healthcare Key takeaways: Contract management in healthcare is about negotiating, executing and monitoring agreements so providers can check that they are being paid in line with their contracts. Managing contracts across hundreds of payers and changing regulatory requirements is complex. Automation, AI and analytics can streamline contract oversight and identify discrepancies earlier. Tools such as Experian Health’s Contract Manager help providers audit payer performance, flag underpayments and manage contracts more efficiently across the contract lifecycle. The front-end data problem behind claim denials Experian Health surveyed 200 healthcare leaders from January to February 2026 to better understand the reasons for claim denials and opportunities for improvement. What are eligibility-related claim denials? Eligibility-related claim denials happen when a payer denies a claim submission for reimbursement due to patient insurance issues. Inaccurate or missing patient insurance information is a top denial trigger and often starts at the front end, during registration. Evolving payer eligibility requirements and new regulatory mandates also make it challenging for providers to avoid eligibility issues that can lead to denials. The most common causes of eligibility errors in healthcare billing 1. Mistakes made during patient intake: Eligibility-related issues often begin during patient intake – especially when providers use manual registration processes, like paper forms. Incorrect patient information entered on the front-end can cause eligibility issues that lead to billing mistakes, reimbursement issues and denials. Experian Health data shows that incomplete or missing insurance patient registration data is a top cause of claim denials, accounting for 32% of denials in 2025.
