JRW / Blog / Statistics

Claim denial statistics, 2026.

How often claims are denied depends on who is counting. Insurers’ own filings put it near one in five; a hospital survey at 15%; MGMA’s practice benchmarks at 7% to 8%. Each figure below carries its sample.

Jeff Weinberg, JRW · Checked 22 October 2026

19%of in-network claims denied by marketplace insurers. KFF, 2024
15%of claims to private payers denied first time. Premier, 516 hospitals
7% to 8%first-submission denials at medical practices. MGMA
< 1%of marketplace denials appealed by patients. KFF

How often claims are denied.

19% (link to this figure)

HealthCare.gov insurers denied 19% of in-network claims in 2024, 85 million of 451 million, and 37% of out-of-network claims. About the same as 2023.

Official: KFF analysis of CMS transparency data, 2024. Insurer filings to CMS, 496 million claims, 2024

KFF excludes claims that were resubmitted and paid, but a denied claim still counts if a new claim was filed in its place. Marketplace plans only, about 7% of the insured.

Cite
JRW, “Claim denial statistics 2026”, https://jrw-tech.com/blog/claim-denial-statistics#den-kff-19, checked 22 October 2026
15% (link to this figure)

Nearly 15% of claims to private payers were denied on first submission.

Survey: Premier Inc., 2024. 516 hospitals in 36 states, 2022 claims

Hospitals, not physician practices.

Cite
JRW, “Claim denial statistics 2026”, https://jrw-tech.com/blog/claim-denial-statistics#den-premier-15, checked 22 October 2026
7% to 8% (link to this figure)

First-submission denial rate at medical practices over the past four years. Below 5% is achievable.

Survey: MGMA Stat, 2026. MGMA DataDive benchmarking, cited July 2026

Cite
JRW, “Claim denial statistics 2026”, https://jrw-tech.com/blog/claim-denial-statistics#den-mgma-7-8, checked 22 October 2026
8% (link to this figure)

Single-specialty first-submission denial rate in 2023, unchanged from 2019.

Survey: MGMA Stat, 2024. 2023 MGMA DataDive Practice Operations

Cite
JRW, “Claim denial statistics 2026”, https://jrw-tech.com/blog/claim-denial-statistics#den-mgma-8, checked 22 October 2026
9% (link to this figure)

Of hospital charges were denied first time in 2016, $262 billion.

Measured, vendor data: Change Healthcare, 2017. 724 hospitals on one vendor’s platform, extrapolated

Cite
JRW, “Claim denial statistics 2026”, https://jrw-tech.com/blog/claim-denial-statistics#den-change-9, checked 22 October 2026
41% (link to this figure)

Of revenue cycle staff say more than 10% of their claims are denied, up from 38% in 2024 and 30% in 2022.

Survey: Experian Health, 2025. 250 healthcare staff, June and July 2025

Opinion survey by a vendor of claims software.

Cite
JRW, “Claim denial statistics 2026”, https://jrw-tech.com/blog/claim-denial-statistics#den-experian-41, checked 22 October 2026
60% (link to this figure)

Of practice leaders said denials were up on the year before. 11% said down.

Survey: MGMA Stat, 2024. 235 practice leaders, March 2024

Cite
JRW, “Claim denial statistics 2026”, https://jrw-tech.com/blog/claim-denial-statistics#den-up-60, checked 22 October 2026

Why.

25% (link to this figure)

Of marketplace denial reasons were administrative. Excluded service 13%, no prior authorization or referral 9%, medical necessity 5%, other 36%.

Official: KFF analysis of CMS transparency data, 2024. Insurer filings, 2024

Claims can carry more than one reason. Insurers do not say which services were denied.

Cite
JRW, “Claim denial statistics 2026”, https://jrw-tech.com/blog/claim-denial-statistics#den-reasons-kff, checked 22 October 2026
23.9% (link to this figure)

Of hospital denials traced to registration and eligibility errors, the leading cause. Missing or invalid claim data 14.6%.

Measured, vendor data: Change Healthcare, 2017. 724 hospitals, 2016

Cite
JRW, “Claim denial statistics 2026”, https://jrw-tech.com/blog/claim-denial-statistics#den-registration-24, checked 22 October 2026
26% (link to this figure)

Of respondents trace at least one denial in ten to intake and registration errors.

Survey: Experian Health, 2025. 250 healthcare staff

Cite
JRW, “Claim denial statistics 2026”, https://jrw-tech.com/blog/claim-denial-statistics#den-intake-26, checked 22 October 2026
48% (link to this figure)

Of medical group leaders named denials and appeals as their largest source of revenue leakage. 23% named front-end errors.

Survey: MGMA Stat, 2026. MGMA Stat poll, January 2026

Cite
JRW, “Claim denial statistics 2026”, https://jrw-tech.com/blog/claim-denial-statistics#den-leakage-48, checked 22 October 2026

What a denial costs.

$43.84 (link to this figure)

Administrative cost per claim to fight a denial, clinical labor excluded. About $19.7 billion a year industry-wide, $10.6 billion of it on claims that should have been paid at submission.

Survey: Premier Inc., 2024. 516 hospitals

Cite
JRW, “Claim denial statistics 2026”, https://jrw-tech.com/blog/claim-denial-statistics#den-cost-4384, checked 22 October 2026
$118 (link to this figure)

Cost to rework a denied claim, the 2017 estimate still widely quoted.

Measured, vendor data: Change Healthcare, 2017. 724 hospitals, 2016

Cite
JRW, “Claim denial statistics 2026”, https://jrw-tech.com/blog/claim-denial-statistics#den-cost-118, checked 22 October 2026
25 min (link to this figure)

A claim status inquiry by phone, the longest manual task CAQH measured. $13.80, against 7 minutes and $3.64 electronically.

Survey: CAQH, 2024. Plans and providers, 2023 data

Cite
JRW, “Claim denial statistics 2026”, https://jrw-tech.com/blog/claim-denial-statistics#den-status-25, checked 22 October 2026

Appeals.

< 1% (link to this figure)

Of in-network marketplace denials were appealed by patients in 2024. Insurers upheld 66% of those appeals.

Official: KFF analysis of CMS transparency data, 2024. Insurer filings, 2024

Cite
JRW, “Claim denial statistics 2026”, https://jrw-tech.com/blog/claim-denial-statistics#den-appealed-1, checked 22 October 2026
54.3% (link to this figure)

Of hospital claims denied first time were eventually paid, after one or more provider appeals.

Survey: Premier Inc., 2024. 516 hospitals

Provider appeals, which are far more common than patient appeals.

Cite
JRW, “Claim denial statistics 2026”, https://jrw-tech.com/blog/claim-denial-statistics#den-paid-54, checked 22 October 2026
63% (link to this figure)

Of denied hospital claims were recoverable, by one vendor’s appeal experience.

Measured, vendor data: Change Healthcare, 2017. One platform, 2016

Cite
JRW, “Claim denial statistics 2026”, https://jrw-tech.com/blog/claim-denial-statistics#den-recoverable-63, checked 22 October 2026
81.7% (link to this figure)

Of appealed Medicare Advantage prior authorization denials were fully or partly overturned in 2023. Only 11.7% of denials were appealed.

Official: KFF analysis of CMS data, via the AMA, 2023. CMS data, Medicare Advantage

Prior authorization, not post-service claims. Here too, most denials are never appealed, and most of those appealed are overturned.

Cite
JRW, “Claim denial statistics 2026”, https://jrw-tech.com/blog/claim-denial-statistics#den-ma-82, checked 22 October 2026

From our work.

One measured engagement and one calculator output.

84% to 96% (link to this figure)

First-pass claim acceptance at a five-provider internal medicine practice, before and after an agent began checking every claim against the payer’s rules. Days in A/R fell from 46 to 31.

JRW engagement: JRW case study, 2026. One engagement, 2026, about 450 claims a week

The case study.

Cite
JRW, “Claim denial statistics 2026”, https://jrw-tech.com/blog/claim-denial-statistics#jrw-accept-84-96, checked 22 October 2026
$184,800 (link to this figure)

What a five-provider practice pays a billing company a year at the calculator defaults. The same calculator prices denials that stop being written off when first-pass denials fall from 10% to 5%.

Our default: JRW, 2026

Medical billing cost calculator.

Cite
JRW, “Claim denial statistics 2026”, https://jrw-tech.com/blog/claim-denial-statistics#jrw-denials-recovered, checked 22 October 2026

The labels.

Measured. Call logs, records or a trial, with a stated sample, from someone not selling a fix for the problem measured.
Measured, vendor data. A vendor’s own platform data, with a stated sample.
Survey. A survey or secret-shopper study, with a stated sample.
Official. Government statistics, statutes and regulations.
Legal analysis. A law firm’s or court’s account of a law or ruling. Not legal advice for your state.
Vendor figure. Published or repeated by a company that sells a related product, with no independent check. Some have no primary source we could find; the note says which. Where a calculator starts from one, its defaults table says so.
JRW engagement. Measured in one of our own client engagements. We sell the work being measured, so read it as one practice’s result, not a benchmark.
Our default. A number we chose, or a JRW calculator’s output at its default settings. The calculator page shows the assumptions.

To cite a figure, copy its cite line. Anchors are stable. Corrections: jeff@jrw-tech.com.

Questions.

Which denial rate applies to my practice?: MGMA’s 7% to 8% is the closest: it is medical practices, first submission, from member data. KFF’s 19% is what marketplace insurers deny across all providers, and it can count a denial that was later paid on a new claim. Premier’s 15% is hospitals. Your clearinghouse report has your own.
Why do the appeal figures differ so much?: KFF counts patient appeals, which almost never happen. Premier counts provider appeals, where more than half of denials are eventually paid. The provider figure is the one a billing desk can act on.
Can I cite these?: Cite KFF, Premier, MGMA, Change Healthcare, Experian or CAQH for their figures. Cite JRW for the case measurement and this page.

Price what denials cost your practice.

The medical billing calculator prices denials that stop being written off, alongside the billing company fee.

Open the medical billing calculator

Claim denial statistics, 2026.

HealthCare.gov insurers denied 19% of in-network claims in 2024, 85 million of 451 million, and 37% of out-of-network claims. About the same as 2023.

Nearly 15% of claims to private payers were denied on first submission.

First-submission denial rate at medical practices over the past four years. Below 5% is achievable.

Single-specialty first-submission denial rate in 2023, unchanged from 2019.

Of hospital charges were denied first time in 2016, $262 billion.

Of revenue cycle staff say more than 10% of their claims are denied, up from 38% in 2024 and 30% in 2022.

Of practice leaders said denials were up on the year before. 11% said down.

Of marketplace denial reasons were administrative. Excluded service 13%, no prior authorization or referral 9%, medical necessity 5%, other 36%.

Of hospital denials traced to registration and eligibility errors, the leading cause. Missing or invalid claim data 14.6%.

Of respondents trace at least one denial in ten to intake and registration errors.

Of medical group leaders named denials and appeals as their largest source of revenue leakage. 23% named front-end errors.

Administrative cost per claim to fight a denial, clinical labor excluded. About $19.7 billion a year industry-wide, $10.6 billion of it on claims that should have been paid at submission.

Cost to rework a denied claim, the 2017 estimate still widely quoted.

A claim status inquiry by phone, the longest manual task CAQH measured. $13.80, against 7 minutes and $3.64 electronically.

Of in-network marketplace denials were appealed by patients in 2024. Insurers upheld 66% of those appeals.

Of hospital claims denied first time were eventually paid, after one or more provider appeals.

Of denied hospital claims were recoverable, by one vendor’s appeal experience.

Of appealed Medicare Advantage prior authorization denials were fully or partly overturned in 2023. Only 11.7% of denials were appealed.

First-pass claim acceptance at a five-provider internal medicine practice, before and after an agent began checking every claim against the payer’s rules. Days in A/R fell from 46 to 31.

What a five-provider practice pays a billing company a year at the calculator defaults. The same calculator prices denials that stop being written off when first-pass denials fall from 10% to 5%.

Price what denials cost your practice.