Variation in Medical Claim Denials: Safety-Net Providers are Hardest Hit

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ID: 324241
2026
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Abstract
Abstract Introduction Medical claim denials impose substantial costs on providers but may also reduce low-value care, resulting in lower expenditures and better quality. Little is known about how denial rates vary across payer and provider segments, including for safety net providers. Methods Using a large, multipayer claims dataset from 2019, we examined initial denials, appeal patterns, and final denials by payer segment, service type, and provider safety-net status. Results Medicaid managed care had the highest initial denial rate for professional claims (15.1 percent), while Medicare Advantage had the highest rates for inpatient (20.0 percent) and outpatient (16.5 percent) claims. Safety-net providers faced uniformly higher initial denial rates than non-safety-net providers across professional (13.6 percent versus 9.2 percent), inpatient (18.3 percent versus 14.7 percent), and outpatient (13.3 percent versus 12.9 percent) services. Conclusion Safety-net providers absorbed a disproportionate share of denial costs. These providers’ lack of negotiating leverage to secure favorable terms with payers could be one driver of these disparities, as could higher rates of low-value care delivery. A standardized framework for the terms and conditions governing payer-provider contracts could help ensure all claims are decided based on the same set of rules.
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Authors Gabe Weinreb, Bruce E. Landon
Journal Health Affairs Scholar
Year 2026
DOI
10.1093/haschl/qxag206
URL
https://doi.org/10.1093/haschl/qxag206
Keywords Keywords not found

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