BC Advantage - 2025 Issue 12

The Denial Dilemma: Why Healthcare Claims Are Failing and How to Fix Them

<p>Claim denials have grown to be more than a nuisance, as they pose a material threat to provider revenue, operational efficiency, and compliance risk. For healthcare facilities, clinics, and specialty providers alike, an increasing share of submitted claims are being denied, appealed, or indefinitely delayed. According to industry benchmarks, denial rates for some practices reach 10% or more of all primary submissions.</p> <p>&nbsp;</p> <p>The costs are consequential: Denied or underpaid claims interfere with cash flow, consume valuable staff resources, increase aged receivables, and carry legal and regulatory implications...

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