Providers have high interest in AI as solution, but adoption is still low
COSTA MESA, Calif.–(BUSINESS WIRE)–Healthcare providers are stuck in a challenging cycle of rising claim denials and data errors, compounded by staffing shortages and outdated technology, according to the Experian Health 2025 State of Claims survey. The findings reveal 41 percent of providers now face denial rates of 10 percent or higher, an issue that has grown each year since the first survey in 2022. While more than two thirds of providers (67%) believe AI can improve the claims process, industry adoption remains low.
Numbers Trending in the Wrong Direction
The survey reveals growing challenges in critical areas affecting financial performance and operational efficiency for providers, including:
- 54 percent of providers say claim errors are increasing
- 68 percent of providers find submitting “clean” claims are more challenging than a year ago
- 43 percent of providers report being understaffed
- 90 percent of claim denials are reworked with at least some human review before resubmission
What’s to blame for claim denials?
A majority of providers (82%) say that reducing denials is a priority. The top three reasons for claim denials remain the same year over year:
- Missing or inaccurate data (50%), up from 46% in 2024
- Authorizations (35%), 36% in 2024
- Incomplete or inaccurate patient registration data (32%), up from 30% in 2024
“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.”
Errors and delays directly affect revenue and cash flow and make the need for technology more urgent than ever. Experian Health has solutions such as Patient Access Curator, which leverages AI and machine learning to streamline the front-end data collection process including eligibility verification, coordination of benefits (COB), Medicare beneficiary identifiers (MBI), insurance discovery and demographics in real time at registration.
AI: High Knowledge, Low Adoption
Although a majority of survey respondents (62%) say they are well-versed in AI, automation, and machine learning (a significant leap from 28% in 2024), only 14 percent are using it. Of that small group using AI, more than two-thirds (69%) say AI solutions have reduced denials and/or increased the success of resubmissions.
“Last year, we invested in Experian Health’s Patient Access Curator and one year in we are already seeing the return on investment,” said Girish Dighe, System Vice President of Revenue Cycle at OhioHealth. “We’ve honed in on the ways the technology can get the front end revenue cycle right.”
In the last year, 41 percent of survey respondents said they upgraded their claims management technology with 56 percent saying their current technology is sufficient to address revenue cycle demands (far below the 77 percent in 2022).
So why aren’t more providers adopting AI? The survey found the top reasons include:
- Unproven accuracy
- Unproven HIPAA compliance
- Daunting training for teams
- Skeptical of AI “understanding” payer-specific rules
Access the free State of Claims report here. The survey was conducted among 250 healthcare professionals responsible for financial, billing, or claims management decisions.
Experian Health offers providers an array of solutions to reduce claim denials and simplify healthcare, including artificial-intelligence-powered products like AI Advantage and Patient Access Curator, which allows providers to capture patient data in real-time with one click. For more information, visit www.experian.com/health.
About Experian Health
At Experian Health, we serve more than 60 percent of U.S. hospitals and more than 7,500 medical practices, labs, pharmacies and other healthcare providers with data-driven platforms and insights that help our clients make smarter business decisions, deliver a better bottom line and establish strong patient relationships.
Experian invests in talented people and new advanced technologies to unlock the power of data and innovate. As a FTSE 100 Index company listed on the London Stock Exchange (EXPN), we have a team of 25,200 people across 32 countries. Our corporate headquarters are in Dublin, Ireland. Learn more at experianplc.com.
For more information about Experian Health, visit http://www.experianhealth.com. Learn more about Experian at www.experianplc.com or visit our global content hub at our global news blog for the latest news and insights from the Group.
Contacts
Sandra Bernardo
Experian
1 949 529 7550
[email protected]
