What You Should Know:
– According to the Experian Health 2025 State of Claims survey, healthcare providers are grappling with a persistent cycle of rising claim denials, data errors, and staffing shortages. The survey was conducted among 250 healthcare professionals responsible for financial, billing, or claims management decisions.
– The survey found that 41% of providers now experience denial rates of 10% or higher, a problem that has grown annually since 2022. Despite widespread belief in the potential of AI, its adoption in the claims process remains low.
A Cycle of Challenges
The survey highlights several growing challenges impacting healthcare organizations:
- Increasing Errors: 54% of providers report that claim errors are on the rise.
- Complexity: 68% of providers find it more challenging to submit “clean” claims than they did a year ago.
- Staffing Shortages: 43% of providers report being understaffed.
- Manual Rework: 90% of claim denials are reworked with at least some human review before being resubmitted.
The top three reasons for claim denials have remained consistent year-over-year: missing or inaccurate data (50%), authorizations (35%), and incomplete or inaccurate patient registration data (32%).
The Promise of AI vs. the Reality of Adoption
While a significant majority of providers (67%) believe AI can improve the claims process, only 14% are currently using it. Of the small group using AI, more than two-thirds (69%) say it has successfully reduced denials and/or increased the success of resubmissions.
The knowledge of AI is growing, with 62% of respondents feeling well-versed in the technology, a substantial increase from 28% in 2024. So, why the slow adoption? The top reasons cited in the survey include concerns about unproven accuracy, unproven HIPAA compliance, the challenge of training teams, and skepticism about AI’s ability to “understand” payer-specific rules.
“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 Health. “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.”
