Medical Billing and Claim-Denial Statistics 2026

The average claim denial rate is roughly 12% of submitted claims, according to the Optum 2024 Revenue Cycle Denials Index, up from 10% in 2020. Rates vary by payer: a Premier Inc. survey found private payers initially deny nearly 15% of claims, and most denied claims are eventually paid.

Quick answer:

• The Optum 2024 Revenue Cycle Denials Index puts the average all-payer denial rate at 12% of claims (2023 data), up from 9% in 2016.
• Premier Inc. found providers spend an average of $43.84 fighting each denied claim, and 54.3% of private-payer denials are ultimately overturned and paid.
• The same Optum index attributes 24% of denials to registration and eligibility, and finds 84% of denials are potentially avoidable.

What is the average claim denial rate?

There is no single "official" denial rate, because it depends on which claims and which payers you count. The most widely cited all-payer figure comes from the Optum 2024 Revenue Cycle Denials Index (published by Optum, formerly Change Healthcare), which analyzed national medical claims data. It puts the average denial rate at 12% in 2023, similar to 2022, up from 10% in 2020 and 9% in 2016. In other words, roughly one in eight claims is denied on first submission, and the trend has moved steadily upward for nearly a decade.

Private payers run higher. A national survey of hospitals, health systems, and post-acute providers conducted by Premier Inc. (2022 claims data, published March 2024) found that nearly 15% of claims submitted to private payers were initially denied. The figure was similar for Medicare Advantage (15.7%) and managed Medicaid (15.1%), both often administered by private payers.

Marketplace plans are higher still. A KFF analysis of 2024 federal transparency data found an average in-network denial rate of 19% across HealthCare.gov marketplace plans. Notably, KFF also found that consumers appealed fewer than 1% of denied claims, a reminder that many denials are simply written off rather than worked.

How much does a denied claim cost to rework?

Every denial carries an administrative price tag on top of the delayed or lost revenue. Premier Inc.'s survey found that providers spend an average of $43.84 to fight a single denied claim, and that getting paid typically takes an average of three review rounds with the payer. Labor drives most of that cost - staff time spent researching, correcting, resubmitting, and appealing.

The math is unforgiving at scale. A practice submitting 1,000 claims a month with a 12% denial rate generates roughly 120 denials, or about $5,260 in rework cost every month before a dollar of the underlying claim is recovered. That is why revenue cycle teams increasingly focus on first-pass accuracy: the cheapest denial is the one that never happens. For a deeper look at where those costs come from and how to cut them, see the guide on how to reduce claim denials and get paid faster.

Days in accounts receivable: the speed of getting paid

Days in accounts receivable (A/R) measures the average time between billing a service and collecting payment. It is one of the clearest signals of billing health, because slow collections tie up cash and often hide a backlog of denials and rejections.

The Medical Group Management Association (MGMA) benchmarks practices on how quickly they clear A/R. MGMA reports that its Better Performers keep more than 70% of their A/R in the 0-to-30-day bucket, meaning the large majority of what they are owed is collected within a month. Practices that let balances age past 30, 60, and 90 days see collection odds fall sharply, so a rising days-in-A/R number is usually an early warning that clean-claim rates or follow-up workflows have slipped.

Clean-claim rate: the metric upstream of everything

If denial rate is the symptom, clean-claim rate is the cause you can control. The clean-claim rate is the share of claims accepted on first submission with no edits, rejections, or denials. The Healthcare Financial Management Association (HFMA) sets 95% as the standard benchmark through its MAP Keys, with 95% to 98% regarded as excellent performance.

The gap between a 95% and an 85% clean-claim rate is enormous in practice. At 85%, a practice submitting 1,000 claims a month reworks 150 of them; at 95%, only 50. Every point of clean-claim rate you recover removes rework cost, shortens days in A/R, and improves cash flow at the same time. Clean claims depend on accurate patient data, verified coverage, and complete documentation captured before the claim is built.

Eligibility errors are the biggest avoidable cause

The single most actionable statistic in denials management is where denials come from. The Optum 2024 Revenue Cycle Denials Index found that 44% of denials are front-end denials, and 24% are caused specifically by registration and eligibility - the largest identifiable category. Crucially, the same index concluded that 84% of denials are potentially avoidable.

Eligibility problems are avoidable because they are knowable before the visit. Verifying active coverage, co-pay, deductible, and out-of-pocket max in real time catches the exact errors that produce a coverage-related denial weeks later. The economics of automating that step are well documented: the 2024 CAQH Index (Council for Affordable Quality Healthcare) found that switching an eligibility and benefit verification from manual to fully electronic saves a medical provider about 12 minutes per transaction, and identified an $11.7 billion annual savings opportunity for the medical industry in eligibility verification alone - the largest of any transaction it measures. For how real-time checks fit into the claim workflow, see this guide to real-time insurance eligibility and claims software.

Billing and claim-denial statistics at a glance

Billing or denial statistic	Figure	Source
Average all-payer claim denial rate (2023)	12%	Optum 2024 Revenue Cycle Denials Index
Private-payer initial denial rate	~15%	Premier Inc. national survey (2022 data)
Private-payer denials ultimately overturned and paid	54.3%	Premier Inc.
Average provider cost to fight a denied claim	$43.84	Premier Inc.
Denials caused by registration and eligibility	24%	Optum 2024 Revenue Cycle Denials Index
Denials that are potentially avoidable	84%	Optum 2024 Revenue Cycle Denials Index
ACA marketplace in-network denial rate (2024)	19%	KFF analysis of 2024 Marketplace data
Clean-claim rate benchmark (target)	95%	HFMA MAP Keys
A/R kept in the 0-to-30-day bucket by Better Performers	>70%	MGMA
Time saved per eligibility check by going fully electronic	~12 minutes	2024 CAQH Index

What the numbers point to

Read together, these statistics tell one story. Denial rates are climbing, most denials trace back to front-end registration and eligibility errors, the large majority of denials are avoidable, and reworking each one costs real money and time. The practices that win on revenue do not out-appeal their peers - they prevent the denial by getting the claim clean the first time.

That is where connected billing and eligibility help most. Ona is an AI-native, all-in-one practice management platform that keeps records, scheduling, billing, and the full insurance cycle on one patient record. Real-time eligibility checks and claim status live on the chart, and invoices and claims are generated from the signed note - so the data behind each claim is captured once and reused, instead of re-keyed across disconnected tools. You can see how that maps to the numbers above on the insurance and eligibility and billing feature pages, or read the guide to the cost of disconnected practice software.

Frequently asked questions

What is the average claim denial rate?

The average all-payer claim denial rate is about 12% of submitted claims, according to the Optum 2024 Revenue Cycle Denials Index (based on 2023 data), up from 10% in 2020 and 9% in 2016. A separate Premier Inc. national survey found that private payers initially deny nearly 15% of claims, though 54.3% of those denials are ultimately overturned and paid.

How much does it cost to rework a denied claim?

Premier Inc.'s national survey of hospitals and health systems (2022 claims data, published March 2024) found that providers spend an average of $43.84 to fight a single denied claim, and that they conduct an average of three review rounds with payers to get paid. Because most denials are potentially avoidable, preventing an error upstream is far cheaper than reworking it.

What is a good clean-claim rate?

The Healthcare Financial Management Association (HFMA) sets a clean-claim rate of 95% as the standard benchmark through its MAP Keys, with 95% to 98% considered excellent. Clean-claim rate is the share of claims accepted on first submission with no edits, rejections, or denials - a leading indicator of how quickly a practice gets paid.

What is a healthy days-in-accounts-receivable benchmark?

The Medical Group Management Association (MGMA) reports that its Better Performers keep more than 70% of accounts receivable (A/R) in the 0-to-30-day bucket, meaning most of what they are owed is collected quickly. Days in A/R measures the average time between billing a service and collecting payment; lower is better.

What causes the most claim denials?

Front-end errors dominate. The Optum 2024 Revenue Cycle Denials Index attributes 44% of denials to front-end issues and 24% specifically to registration and eligibility, making eligibility the single largest identifiable cause. The same index finds 84% of denials are potentially avoidable, and most stem from missing, inaccurate, or unverified information collected before the visit.

Can most denied claims be recovered?

Often, yes, but at a cost. Premier Inc. found that 54.3% of private-payer denials are ultimately overturned and paid after providers work them. Recovery consumes staff time and money - an average of $43.84 per claim and multiple review rounds - which is why preventing denials generally beats appealing them.

Next step

If these numbers match what your billing feels like - climbing denials, slow collections, too many claims reworked by hand - it is worth seeing what a connected workflow looks like. Book a 15-min walkthrough - no obligation to see how Ona handles real-time eligibility, claim generation from the signed note, and the full insurance cycle on one patient record. Every feature is available on a 14-day free trial with no credit card required, and migration from your current system is free within one business day.