October 31, 2026 | Healthcare Industry News

Healthcare providers across the United States are facing continued challenges with insurance claim denials, according to a new 2026 State of Claims survey by Experian Health. The findings highlight the growing importance of accurate medical coding, proper clinical documentation and effective revenue cycle management.

According to a report published by Medical Economics on October 30, 2026, 40% of healthcare providers surveyed reported that at least 10% of their claims were being denied.

Services Not Covered Becomes the Leading Reason for Claim Denials

The survey identified services not covered by insurance policies as the most frequently reported reason for claim denials.

Other major reasons included:

Frequently changing insurance payer policies.

Inaccurate medical coding.

Difficulties obtaining prior authorisation.

Missing or insufficient clinical documentation.

Code inaccuracy and prior authorisation challenges were each identified among the top three denial reasons by 25% of respondents.

Medical Coding Accuracy Plays a Critical Role

Accurate medical coding is essential for successful healthcare reimbursement. Even minor coding errors, incorrect code selection or insufficient documentation can lead to rejected or denied insurance claims.

Professional medical coders help healthcare organisations by:

Reviewing clinical documentation carefully.

Assigning appropriate ICD-10-CM, CPT and HCPCS codes.

Following official coding guidelines.

Identifying documentation gaps.

Supporting accurate claim submission.

Helping reduce preventable coding-related denials.

AI and Technology in Claims Management

The survey also highlighted the growing interest in artificial intelligence and automation in healthcare claims management.

Although only 9% of respondents reported currently using AI in claims processes, 64% said their organisations were considering investing in AI for claims and denial management.

This reflects the growing role of technology in healthcare revenue cycle management. However, human expertise and coding knowledge remain important for reviewing complex medical records and ensuring coding accuracy.

What This Means for Aspiring Medical Coders

As healthcare organisations continue to focus on accurate reimbursement and reducing claim denials, professionals with strong medical coding knowledge and an understanding of revenue cycle management can prepare themselves for evolving industry requirements.

Learning ICD-10-CM, CPT, HCPCS, medical terminology and clinical documentation is an important foundation for building a career in medical coding.

Conclusion

The latest healthcare claims survey highlights how coding accuracy, documentation quality and changing insurance policies influence the reimbursement process.

As the healthcare industry continues to evolve, skilled medical coding professionals remain an important part of maintaining accurate healthcare records and supporting efficient revenue cycle operations.

Build your healthcare career with the right skills and industry knowledge.

Explore professional medical coding training opportunities at CIGMA Medical Coding.