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New Report Shows Average Hospital Claim Denial Rate Continues to Trend Upward

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A recent analysis of more than 102 million claim remits for 1,500 hospitals shows medical claim denials are on an upward trajectory. While COVID-19 appears to be exacerbating the problem, data from the second half of 2019 shows the increase was already well underway before the pandemic.

The Change Healthcare 2020 Denials Index is an analysis of 102 million hospital transactions valued at $407 billion in total charges across more than 1,500 U.S. hospitals. The research insights were drawn from Change Healthcare’s data network, one of the largest in U.S. healthcare with more than 1 million physicians, 6,000 hospitals, and 2,400 payer connections; touching 1 in 3 U.S. patient records; and processing 15 billion healthcare transactions worth $1.5 trillion annually.

The report found the average denials rate is up 23% since 2016, topping 11.1% of claims denied upon initial submission through the third quarter of 2020. Since the onset of COVID-19, denials have risen 11% nationally, with the highest denial rates in regions with the highest first-wave of COVID-19 outbreaks: the Pacific Coast and the Northeast, both topping 13% of claims denied on initial submission in 2020.

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