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’s2025 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Inaccurate insurance data: Outdated patient insurance information, missing coverage or mistakes made when entering insurance data during registration can lead to rejected or denied claims.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.
