Key takeaways:
- Experian Well being’s State of Claims 2025 report is out now, detailing suppliers’ views on claims administration and the way these have modified for the reason that survey started in 2022.
- Declare denials are nonetheless on the rise, inflicting suppliers to search out quicker and extra environment friendly methods to submit clear claims the primary time.
- In terms of options, optimism about synthetic intelligence (AI) is excessive, however uptake stays surprisingly low.
- AI-powered instruments like Patient Access Curator™ and AI Advantage™ may also help healthcare suppliers scale back declare denials whereas optimizing the claims administration course of.
Based on Experian Health’s State of Claims 2025 report, declare denials proceed to negatively affect America’s healthcare suppliers. This quantitative survey of 250 healthcare professionals, carried out in June and July 2025, reveals suppliers’ issues about rising denial charges, staffing shortages and uncertainty over whether or not payers or sufferers will finally pay. The findings show that suppliers are open to new claims processing and denial discount options. Nevertheless, whereas suppliers are smitten by synthetic intelligence’s capacity to ease the squeeze, solely a small fraction are literally utilizing it.
This text highlights a couple of key takeaways from healthcare suppliers’ statements in regards to the present challenges in claims administration and the elements that contribute to their responses.
Takeaway 1: Declare denials are on the rise once more
This year’s survey confirms what suppliers have been seeing for a number of years: declare denials are usually not letting up. In 2022, 30% reported that no less than 10% of their claims had been denied. By 2024, the determine had grown to 38%. Now, in 2025, 41% of suppliers say their claims are denied over 10% of the time. If this pattern continues, how a lot additional might denial charges climb?
Declare denials have gotten a rising a part of on a regular basis operations, demanding extra time, employees and assets. Margins that are already under pressure are strained additional by missed reimbursements. And when insurers don’t pay, extra of the invoice falls to sufferers, lots of whom are already struggling to handle medical prices. Half of respondents mentioned they’re “very or extraordinarily involved” about sufferers’ capacity to pay, up six percentage points from last year. For a lot of organizations, the query shouldn’t be whether or not denials will proceed, however how finest to forestall them earlier than the monetary burden worsens.
Takeaway 2: How unhealthy knowledge results in extra healthcare declare denials
The report lists a number of of the highest triggers for denials, however inaccurate and incomplete knowledge proceed to face out. More than half of providers (54%) say claim errors are increasing, and almost seven in ten (68%) report that submitting clear claims is more difficult than it was a yr in the past.
Many of those errors originate at registration. Incomplete or inaccurate info collected throughout check-in is now the third commonest reason behind denials, with 26% of respondents saying that no less than one in ten denials at their group could be traced again to consumption errors. Each mistake sends ripples downstream, resulting in expensive rework, avoidable cost delays and pointless affected person stress.
Tightening up affected person entry processes and correct knowledge assortment is without doubt one of the finest issues suppliers can do to curb denials. With that in thoughts, Experian Health’s Patient Access Curator is designed to assist suppliers seize correct knowledge the primary time. Utilizing AI and machine studying, it consolidates eligibility checks, coordination of advantages, Medicare Beneficiary Identifier (MBI) verification, demographics, insurance coverage protection and monetary standing right into a single workflow. This enables suppliers to:
- Shortly accumulate correct affected person info upfront
- Remove the necessity to re-run eligibility checks, which now take greater than 10 minutes for over half of suppliers
- Cut back guide knowledge entry errors that result in downstream denials
- Unlock employees time for higher-value duties
Takeaway 3: An AI paradox in healthcare claims: Excessive optimism, low adoption
Affected person Entry Curator is a good instance of how AI can help address the data problems behind denials. However clear knowledge alone isn’t sufficient. Errors and dangers nonetheless emerge mid-cycle. Right here, AI Advantage affords one other software for AI, utilizing predictive analytics to establish high-risk claims earlier than submission and routing them for correction. It additionally triages denials based mostly on the probability of reimbursement, so employees don’t lose time on unproductive rework.
69% of healthcare suppliers who use AI say that AI options have lowered denials and/or elevated the success of resubmissions.
The survey exhibits many suppliers are smitten by AI’s potential: 67% consider AI can enhance the claims course of, and 62% are very assured of their understanding of how AI differs from automation and machine studying, up sharply from simply 28% in 2024.
Regardless of this optimism, adoption is surprisingly low. Only 14% of providers are currently using AI to cut back denials. The survey means that though the vast majority of AI adopters report fewer denials and extra profitable resubmissions, concern of the unknown appears to be slowing progress.
Takeaway 4: Tech upgrades aren’t sufficient with out integration
Even when they continue to be on the fence about AI, suppliers are nonetheless transferring to modernize claims administration. Solely 56% consider their present know-how is adequate to deal with income cycle calls for, a major drop from 77% in 2022. This explains why 55% are prepared to utterly change their present claims administration platform if introduced with a compelling return on funding.
A lot of the frustration comes from fragmentation. Practically eight in ten providers say their organizations nonetheless depend on a number of options to gather the data wanted for a declare submission. Switching between techniques slows down consumption, creates duplication and will increase the danger of errors that feed immediately into denials.
An built-in resolution like Patient Access Curator solves this downside by changing a patchwork of instruments with a single platform that manages consumption and eligibility in a single workflow. Info is captured in a single place, decreasing the duplication and errors which can be inevitable when knowledge is entered into a number of databases. Extending this with AI Advantage hyperlinks front-end accuracy with back-office intelligence, giving suppliers a linked denial-prevention system slightly than stitching collectively remoted fixes. With fewer instruments to log into, employees can work extra effectively and deal with submitting cleaner claims.
Discover how Experian Well being is reshaping the way in which well being techniques handle Coordination of Advantages. Learn the way automation and AI are eliminating guide errors, decreasing denials and unlocking hundreds of thousands in recoverable income.
Closing the know-how gaps in claims administration to forestall denials
The 2025 State of Claims report clearly exhibits that denials stay a persistent and dear downside for healthcare organizations. An amazing majority say that decreasing them is a prime organizational precedence.
Past the monetary issues, the survey reveals a system nonetheless held again by knowledge errors, fragmented know-how and delays. On the similar time, there are hints of cautious optimism. Final yr, many suppliers felt in the dead of night about AI and machine studying. This yr’s survey exhibits that consciousness of those applied sciences has grown significantly, even when adoption remains to be early. Because the report sheds gentle on how leaders are weighing investments in new know-how, the query now could be whether or not suppliers can flip rising confidence in AI into motion that delivers the outcomes they want.
To see the complete image of the place claims administration stands at present, and the place it might go subsequent, download the State of Claims 2025 report.
