It's the end of a long clinic day. Your last patient has gone home and the notes are signed. Then you remember the claims that still haven’t been paid, the denials waiting for a reply, and the money that should have come in weeks ago.
Sounds familiar? You’re not the only one. Getting paid for the care you give has become harder for most practices, but you don’t have to deal with it alone.
Where do claim denials stand in 2026?
Kodiak Solutions data from 2,400 hospitals and 375,000 physicians shows the average initial claim denial rate fell to 10.63% in the first half of 2026, down from 12.00% a year earlier. That is progress, but roughly 1 in 10 claims still gets denied on the first pass.
For private payers the initial denial rate sits near 19.98%.
Experian Health’s October 2026 State of Claims report paints a similar picture:
✅ 40% of providers say 10% or more of their claims are denied (about the same as last year, but up from 31% in 2022).
✅ 65% say clean claims are harder to submit than a year ago.
✅ 64% say they are waiting longer to get paid.
✅ Only 30% recover most of the revenue they lose to denials.
Denials have stopped climbing as sharply, but they remain high enough to drain time and delay cash you have already earned.
Why are claims getting denied in 2026?
For the first time in Experian’s survey, “services not covered” ranked as the top reason providers named, at 53%. Next came payer policy changes at 31%, then coding errors and prior authorization problems, tied at 25%.
Most of these start small. A note is missing a detail. A code does not quite match the chart. A payer changes a rule and nobody on the team hears about it until the denial arrives. It gets worse when billing, denials, and AR are handled by different people. Each person sees only their own piece, and nobody owns the full picture.
How does outsourcing medical billing and collections help?
A good billing partner does this work all day, every day. They track payer rules, catch errors before a claim goes out, and follow up on unpaid claims so your staff does not have to.
That is how Nivaran’s Revenue Cycle Management services work. One team handles charge entry and audit, claims, denials and appeals, and payment posting. Because the same team owns every step, problems get caught early and fixed quickly. There are no upfront fees.
Practices working with Nivaran have reported an under 3.5% denial rate and a 97%+ clean claim rate. Compare that with the industry average of about 10-11%. Nivaran’s team includes 500+ AAPC/AHIMA-certified coders. They process over 10 million transactions a year, support 400+ health organizations, and connect with 50+ EMRs, so you will not need to switch systems.
These figures are company-reported from current clients. Your results will depend on specialty, payer mix, and current setup. Ask how each metric is calculated, what period it covers, and what sample size it represents. A credible partner will answer those questions clearly.
What does good collection work look like?
Collections take more than sending a claim and waiting. A strong partner will:
✅ Follow up on unpaid and underpaid claims
✅ Track balances by payer and by age
✅ Spot underpayments you might miss
✅ Handle patient balances when needed
The aim is to keep money coming in without your staff spending their days on hold with payers.
Five questions to ask before you sign
Before you choose a partner, ask them:
1. How does your pricing work?
2. What reports will I get, and how often?
3. How do you find the root cause of denials?
4. What security and compliance steps do you follow?
5. Have you worked with my specialty and my main payers?
If they answer clearly and specifically, that is a good sign. If the answers are vague, look elsewhere.
How do you know outsourcing is working?
Before you start, write down five numbers: denial rate, clean claim rate, days in AR, collection rate, and first-pass resolution rate. Check them again after 90 days. If they have improved, your money is moving faster.
Why documentation experience matters
Nivaran has worked in medical documentation since 1999. Its team knows how notes, coding, and billing affect each other - something many billing-only companies do not. Clean claims start with accurate notes. Outsourcing does not mean losing control of your billing. It means your team spends more time with patients and less time on paperwork.
Ready for fewer denials and faster payments?
Book a call with Nivaran. You can keep the system you already use.
Frequently asked questions
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